Provider Demographics
NPI:1366465262
Name:HEARTLAND PODIATRY
Entity Type:Organization
Organization Name:HEARTLAND PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:PICHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-401-8471
Mailing Address - Street 1:1048 WOODLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-4948
Mailing Address - Country:US
Mailing Address - Phone:515-401-8471
Mailing Address - Fax:515-401-8471
Practice Address - Street 1:1048 WOODLAND PARK DR
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-4948
Practice Address - Country:US
Practice Address - Phone:515-401-8471
Practice Address - Fax:515-401-8471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00425213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4217562Medicaid
IA51743OtherBLUE CROSS BLUE SHIELD
IAT01229Medicare UPIN
IA51743Medicare ID - Type Unspecified