Jim Paul Licandro in Long Grove - Podiatrist
Jim Paul Licandro - NPI 1609873538
Jim Paul Licandro is a Podiatrist in Long Grove, Iowa. Jim Paul Licandro practices all healthcare services and medical treatments related to Podiatrist. The NPI Number for Jim Paul Licandro is 1609873538. The last update date is 2018-07-22.
Jim Paul Licandro's current location address is 405 Woodlawn Rd, Long Grove, Iowa. You can contact this provider via phone number 8324257457 and fax number 5632855446. The mailing address for Jim Paul Licandro is 405 Woodlawn Rd, Long Grove, Iowa. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jim Paul Licandro |
|---|---|
| Address | 405 Woodlawn Rd, Long Grove, Iowa |
| Phone Number | 8324257457 |
| Fax Number | 5632855446 |
| Sole Proprietor | N |
| Credentials | DPM |
NPI Number Detail
| NPI Number | 1609873538 |
|---|---|
| Provider Enumeration Date | 2005-07-07 |
| Last Updated Date | 2018-07-22 |
Provider Mailing Address Detail
| Address | 405 Woodlawn Rd |
|---|---|
| City | Long Grove |
| State | Iowa (IA) |
| Post Code | 527560 |
| Phone Number | 8324257457 |
| Fax Number | 5632855446 |
Provider's Primary Taxonomy Detail
| Speciality | Podiatrist |
|---|---|
| Taxonomy | 213E00000X |
| Licence No | 705 |
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Definition: A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1197210 | IA | -- |
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What is the unique identifier code issued to Jim Paul Licandro by the Centers for Medicare & Medicaid Services?
The Jim Paul Licandro has been assigned the NPI (National Provider Identifier) 1609873538. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Can you provide the Jim Paul Licandro's physical address?
The Jim Paul Licandro is physically located at 405 Woodlawn Rd, in the city of Long Grove, IA, with the postal code 527560.
What is Jim Paul Licandro's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Jim Paul Licandro is Podiatrist, and the taxonomy code that categorizes this field of expertise is 213E00000X.
When did the Jim Paul Licandro receive its 1609873538?
The Jim Paul Licandro was issued its 1609873538 on 2005-07-07, which is the date when the organization was assigned this unique identifier.
As of what date was the information regarding Jim Paul Licandro, such as address, specialty, and other details, last verified and confirmed to be up-to-date?
The information related to Jim Paul Licandro, including its address, specialty, and other relevant details, was last verified and confirmed to be up-to-date on 2018-07-22.
NPI Number: 1336142389
Address: Po Box 2004, East Syracuse, NY