Basic Information
| Provider Information | |||||||||
| NPI: | 1033645189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOLEIMANI | ||||||||
| FirstName: | MINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 10TH ST SE | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524032414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193647730 | ||||||||
| FaxNumber: | 8777813981 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 10TH ST SE | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524032414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193647730 | ||||||||
| FaxNumber: | 8777813981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 08/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R-10812 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD-46492 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.