Provider Demographics
NPI:1053520403
Name:SUNDQUIST, PHILIP DEWAIN (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DEWAIN
Last Name:SUNDQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 N 7TH ST
Mailing Address - Street 2:PO BOX 674
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1206
Mailing Address - Country:US
Mailing Address - Phone:641-217-9115
Mailing Address - Fax:
Practice Address - Street 1:1030 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049-1206
Practice Address - Country:US
Practice Address - Phone:641-217-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26013207Q00000X
IA37367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA70228OtherWELLMARK
IA6400210Medicaid
IAP00446116Medicare Oscar/Certification
IAI20821Medicare PIN