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1720445281
PREMIER PODIATRY
LONG GROVE, IA
NPI
1720445281
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Entity Type
Organization
Authorized Contact
JAMES P LICANDRO
Owner/Physician
563-340-4387
Organization Subpart ?
No
Primary Taxonomy
213E00000X Podiatrist
(Licence: IA 0705)
Enumeration Date
2016-01-28
Last Update Date
2022-07-21
Business Address
PREMIER PODIATRY
405 WOODLAWN RD
LONG GROVE, IA 52756-8745
Phone number: 832-425-7457
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Mailing Address
PREMIER PODIATRY
PO BOX 2671
DAVENPORT, IA 52809-2671
Phone number: 832-425-7457
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