Provider Demographics
NPI:1417920265
Name:DUBUQUE PODIATRY PC
Entity Type:Organization
Organization Name:DUBUQUE PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:563-557-5930
Mailing Address - Street 1:1500 DELHI ST
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6358
Mailing Address - Country:US
Mailing Address - Phone:563-557-5930
Mailing Address - Fax:563-557-5936
Practice Address - Street 1:1500 DELHI ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6358
Practice Address - Country:US
Practice Address - Phone:563-557-5930
Practice Address - Fax:563-557-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA44134OtherGROUP BLS NUMBER
IA0133959Medicaid
IL04332003OtherBLUE SHIELD GRP NUMBER
IACD8232OtherRAILROAD MEDICARE GRP NUM
IL04332003OtherBLUE SHIELD GRP NUMBER
IL543190Medicare PIN
IA3983020001Medicare NSC