Provider Demographics
NPI:1124099932
Name:PECHOLT, EMIL J (DO)
Entity type:Individual
Prefix:DR
First Name:EMIL
Middle Name:J
Last Name:PECHOLT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N 9TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3905
Mailing Address - Country:US
Mailing Address - Phone:515-574-6890
Mailing Address - Fax:
Practice Address - Street 1:608 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1000
Practice Address - Country:US
Practice Address - Phone:712-335-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33942207Q00000X
IA2804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN838002300Medicaid
IA1124099932Medicaid
IAP00710402OtherRR MEDICARE - DC
IAP00725349OtherRR MEDICARE - SG
MN080014454Medicare ID - Type Unspecified
IAP00725349OtherRR MEDICARE - SG
IAP00710402OtherRR MEDICARE - DC
IAI1416009Medicare PIN