Provider Demographics
NPI:1841283637
Name:RARICK, BRIAN KENNETH (DPM)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KENNETH
Last Name:RARICK
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:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-0146
Mailing Address - Country:US
Mailing Address - Phone:712-542-4221
Mailing Address - Fax:712-542-5393
Practice Address - Street 1:300 N 17TH ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1510
Practice Address - Country:US
Practice Address - Phone:712-542-4221
Practice Address - Fax:712-542-5393
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00478213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE42137486900Medicaid
IA1273680Medicaid
IA71301659OtherUNITED HEALTH CARE
MI4653266Medicaid
SD6800510Medicaid
IA04758OtherWELLMARK BCBS
MI4653266Medicaid
NE42137486900Medicaid