Provider Demographics
NPI:1902596984
Name:LUSE, DOLIDO IKALABA SR (MD)
Entity Type:Individual
Prefix:
First Name:DOLIDO
Middle Name:IKALABA
Last Name:LUSE
Suffix:SR
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 1:5170 16TH AVENUE SOUTHWEST
Mailing Address - Street 2:13
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-6708
Mailing Address - Country:US
Mailing Address - Phone:319-899-7043
Mailing Address - Fax:
Practice Address - Street 1:5170 16TH AVENUE SOUTHWEST
Practice Address - Street 2:13
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-6708
Practice Address - Country:US
Practice Address - Phone:319-899-7043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IALUV782347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle