Provider Demographics
NPI:1821269333
Name:FRUSH, KATHERINE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:FRUSH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:FRUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:3200 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4104
Mailing Address - Country:US
Mailing Address - Phone:515-271-1731
Mailing Address - Fax:515-271-1692
Practice Address - Street 1:3200 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4104
Practice Address - Country:US
Practice Address - Phone:515-271-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000807213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00646817OtherRR MEDICARE
IA1821269333Medicaid
IA41530004Medicare PIN