Provider Demographics
NPI:1750359147
Name:BINGAMAN, AMY (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BINGAMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:NIEDERHAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1212 PLEASANT ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1414
Mailing Address - Country:US
Mailing Address - Phone:515-243-8842
Mailing Address - Fax:515-282-9806
Practice Address - Street 1:1212 PLEASANT ST
Practice Address - Street 2:SUITE 405
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1414
Practice Address - Country:US
Practice Address - Phone:515-243-8842
Practice Address - Fax:515-282-9806
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235594207VG0400X
IAMD-38493207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1750359147Medicaid
IA719260202Medicare PIN