Provider Demographics
NPI:1407812993
Name:PODIATRY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:319-365-6973
Mailing Address - Street 1:3053 CENTER POINT RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4049
Mailing Address - Country:US
Mailing Address - Phone:319-365-6973
Mailing Address - Fax:319-365-6974
Practice Address - Street 1:3053 CENTER POINT RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4049
Practice Address - Country:US
Practice Address - Phone:319-365-6973
Practice Address - Fax:319-365-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0433086Medicaid
IA71953Medicare PIN