Provider Demographics
NPI:1689666794
Name:PRIKASZCZIKOW, EDWARD N (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:N
Last Name:PRIKASZCZIKOW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 MCKENZIE AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1002
Mailing Address - Country:US
Mailing Address - Phone:712-328-0297
Mailing Address - Fax:712-328-2403
Practice Address - Street 1:320 MCKENZIE AVE
Practice Address - Street 2:STE 102
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1002
Practice Address - Country:US
Practice Address - Phone:712-328-0297
Practice Address - Fax:712-328-2403
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA368213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0004200Medicaid
IA06476Medicare PIN
IAT01018Medicare UPIN
IA0803130001Medicare NSC
IA0004200Medicaid