Provider Demographics
NPI:1881676120
Name:BISSING, MARK S (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:BISSING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9170
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-9170
Mailing Address - Country:US
Mailing Address - Phone:515-633-3600
Mailing Address - Fax:515-633-3838
Practice Address - Street 1:5880 UNIVERSITY AVE STE 102
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8209
Practice Address - Country:US
Practice Address - Phone:515-633-3600
Practice Address - Fax:515-288-0840
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02787207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA110136970OtherRAILROAD MEDICARE
IA2098491Medicaid
IA50691Medicare ID - Type Unspecified
IA110136970OtherRAILROAD MEDICARE