| NPI | 1013179506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TELETHA JEAN MAXSON Billing 563-263-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 00484) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 00542) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2008-06-26 |