Provider Demographics
NPI:1104119189
Name:PROFESSIONAL FOOT AND ANKLE CARE INC PC
Entity type:Organization
Organization Name:PROFESSIONAL FOOT AND ANKLE CARE INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-337-2021
Mailing Address - Street 1:805 S GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-1742
Mailing Address - Country:US
Mailing Address - Phone:319-337-2021
Mailing Address - Fax:319-337-8411
Practice Address - Street 1:805 S GILBERT ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-1742
Practice Address - Country:US
Practice Address - Phone:319-337-2021
Practice Address - Fax:319-337-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0110122Medicaid
IAU31834Medicare UPIN
IA15973Medicare PIN