Provider Demographics
NPI:1114991262
Name:CHECK, KELLY L (DPM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:CHECK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S 19TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-2902
Mailing Address - Country:US
Mailing Address - Phone:515-382-5413
Mailing Address - Fax:515-382-7107
Practice Address - Street 1:640 S 19TH ST STE 100
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201
Practice Address - Country:US
Practice Address - Phone:515-382-5413
Practice Address - Fax:515-382-7107
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1710235213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
59069OtherWELMARK
IA0266890Medicaid
IA1266890Medicaid
IA2266890Medicaid
59063OtherWELMARK
59066OtherWELMARK
IA2266890Medicaid
59063OtherWELMARK
U92758Medicare UPIN
I7208Medicare ID - Type Unspecified