Provider Demographics
NPI:1174597116
Name:ZMOLEK BECK, MARY GWEN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GWEN
Last Name:ZMOLEK BECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GWEN
Other - Last Name:ZMOLEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-4241
Mailing Address - Fax:319-356-3086
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:319-356-4241
Practice Address - Fax:319-356-3086
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA59985OtherWELLMARK BCBS
IA0160135Medicaid
IA0160135Medicaid
IA59985Medicare PIN