Provider Demographics
NPI:1689700593
Name:WIRTZ, PETER DWIGHT (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:DWIGHT
Last Name:WIRTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-0355
Mailing Address - Country:US
Mailing Address - Phone:515-278-5811
Mailing Address - Fax:515-981-0420
Practice Address - Street 1:7601 OFFICE PLAZA DR N
Practice Address - Street 2:SUITE 115
Practice Address - City:W DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-2338
Practice Address - Country:US
Practice Address - Phone:515-278-5811
Practice Address - Fax:515-981-0420
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17314207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0030767Medicaid
IA0030767Medicaid
IAA00966Medicare UPIN