Provider Demographics
NPI:1730299785
Name:MIDWEST PODIATRY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MIDWEST PODIATRY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-270-2363
Mailing Address - Street 1:3001 E 43RD ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-4076
Mailing Address - Country:US
Mailing Address - Phone:515-270-2363
Mailing Address - Fax:515-331-1080
Practice Address - Street 1:3001 E 43RD ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-4076
Practice Address - Country:US
Practice Address - Phone:515-270-2363
Practice Address - Fax:515-331-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00619213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7135319Medicaid
IAU59380Medicare UPIN
IA7135319Medicaid