Provider Demographics
NPI:1538853908
Name:SITUMEANG, CARLIN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:CARLIN
Middle Name:MICHAEL
Last Name:SITUMEANG
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 1:506 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52623-9609
Mailing Address - Country:US
Mailing Address - Phone:319-931-9507
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-384-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-12837207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine