Provider Demographics
NPI:1316056278
Name:DUBUQUE PODIATRY, PC
Entity type:Organization
Organization Name:DUBUQUE PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:563-557-5930
Mailing Address - Street 1:1500 DELHI ST
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6358
Mailing Address - Country:US
Mailing Address - Phone:563-557-5930
Mailing Address - Fax:563-557-5936
Practice Address - Street 1:420 1ST AVE E
Practice Address - Street 2:
Practice Address - City:DYERSVILLE
Practice Address - State:IA
Practice Address - Zip Code:52040-1326
Practice Address - Country:US
Practice Address - Phone:563-557-5930
Practice Address - Fax:563-557-5936
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUBUQUE PODIATRY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1133959Medicaid
IA44134OtherGROUP BLUE SHIELD NUMBER
IA1133959OtherGROUP T-19 NUMBER
IA1133959OtherGROUP T-19 NUMBER
IA44134OtherGROUP BLUE SHIELD NUMBER