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1609873538
JIM PAUL LICANDRO
LONG GROVE, IA
NPI
1609873538
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Other Name
JAMES PAUL LICANDRO
Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
213E00000X Podiatrist
(Licence: IA 00705)
Enumeration Date
2005-07-07
Last Update Date
2018-07-22
Business Address
Dr. JIM PAUL LICANDRO DPM
405 WOODLAWN RD
LONG GROVE, IA 52756
Phone number: 832-425-7457
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Mailing Address
Dr. JIM PAUL LICANDRO DPM
5261 BOULDER DR APT D
WEST DES MOINES, IA 50265-7823
Phone number: 563-340-4387
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