Provider Demographics
NPI:1801075858
Name:RUDOLPH LAFONTANT, DPM, PC
Entity type:Organization
Organization Name:RUDOLPH LAFONTANT, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-963-9464
Mailing Address - Street 1:1701 22ND ST STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1443
Mailing Address - Country:US
Mailing Address - Phone:515-963-9464
Mailing Address - Fax:515-963-9467
Practice Address - Street 1:1701 22ND ST STE 105
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1443
Practice Address - Country:US
Practice Address - Phone:515-963-9464
Practice Address - Fax:515-963-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00597213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE4738OtherRAILROAD MEDICARE
IA0934390001OtherDMERC
IA0415927Medicaid
IAU47297Medicare UPIN
IA0415927Medicaid