Provider Demographics
NPI:1912278490
Name:COLLIN E. PEHDE DPM, PLLC
Entity type:Organization
Organization Name:COLLIN E. PEHDE DPM, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PEHDE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-282-6067
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:500 E COURT AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2057
Practice Address - Country:US
Practice Address - Phone:515-282-6067
Practice Address - Fax:515-244-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00782213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6699000001Medicare NSC
IAIB2440Medicare PIN