PREMIER PODIATRY (NPI# 1720445281) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720445281 |
| Entity Type | Organization |
| Organization Name | PREMIER PODIATRY |
| Practice Address |
405 Woodlawn Rd Long Grove IA 52756-8745 |
| Mailing Address |
Po Box 2671 Davenport IA 52809-2671 |
| Practice Telephone | 8324257457 |
| Practice Fax Number | 5634247234 |
| Mailing Telephone | (832) 425-7457 |
| Mailing Fax Number | 5632855447 |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2017-07-13 |
| Authorized Official Name | DR. JAMES P LICANDRO (OWNER/PHYSICIAN) |
| Authorized Official Telephone | 5633404387 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | 0705 | IA | Podiatric Medicine & Surgery Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336440833 | Premier Podiatry | Podiatrist | 1702 Dexter Ave N, Seattle, WA 98109-3021 | 2010-11-15 |
| 1316267693 | Premier Podiatry | Podiatrist | 1930 Crown Park Ct, Suite 120, Columbus, OH 43235-2402 | 2010-06-09 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PREMIER PODIATRY GROUP | 3133 New Germany Rd Ste 62, Ebensburg, PA 15931-4348 |
| Virginia Business Entities | Premier Podiatry LLC | Two James Center, 1021 E Cary St 17th Fl, Richmond, Virginia 23219 |
| Colorado Business Entities | Premier Podiatry of Colorado, Inc. | 7470 S Sheridan Ct, Littleton, CO 80128 |
| Iowa Business Entities | PREMIER PODIATRY, LLC | 608 Main St, 171, Bagley, IA 50026 |
| Street Address |
405 WOODLAWN RD |
| City | LONG GROVE |
| State | IA |
| Zip Code | 52756-8745 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609873538 | Jim Paul Licandro | Podiatrist | 405 Woodlawn Rd, Long Grove, IA 52756 | 2005-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780003160 | Kimberly Larson | Physical Therapy Assistant | 30980 Scott Park Rd Trlr 72, Long Grove, IA 52756-9641 | 2014-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790390805 | Kimberly Hannah Kupferberg | Family Medicine | 1103 Schaeffer Rd, Long Grove, IL 60047-5153 | 2020-09-15 |
| 1285244749 | Briana Marie Certa | Occupational Therapist | 1190 Old Mchenry Rd, Long Grove, IL 60047-5088 | 2020-08-08 |
| 1558982637 | Liv Home Health LLC | In Home Supportive Care | 4427 Pebble Creek Ln, Long Grove, IL 60047-5283 | 2020-04-30 |
| 1932736618 | Sofia Hossain | Student in an Organized Health Care Education/Training Program | 4842 Wilderness Ct, Long Grove, IL 60047-5184 | 2020-03-24 |
| 1720615321 | Ronie Dana Vardy | Physician Assistant | 6852 Indian Creek Rd, Long Grove, IL 60047-5110 | 2020-03-24 |
| 1104453869 | Felice Block Ma Lcpc | Clinic/Center | 4160 Il Route 83 Ste 206, Long Grove, IL 60047-8034 | 2020-03-24 |
| 1316599731 | Tamara Hubbard, Lcpc, LLC | Counselor | 4160 Il Route 83 Ste 210, Long Grove, IL 60047-8034 | 2019-07-16 |
| 1316504095 | Jennifer Navarro | Social Worker | 4180 Il Route 83 Ste 10, Long Grove, IL 60047-9563 | 2019-05-28 |
| 1891259370 | Mindy Waxman | Psychologist | 5860 Rock Dove Ct, Long Grove, IL 60047-5062 | 2019-01-29 |
| 1184127516 | Robert J. Villa | Dentist | 5471 Rfd, Long Grove, IL 60047-8211 | 2018-03-12 |
| Find all providers in LONG GROVE | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609873538 | Jim Paul Licandro | Podiatrist | 405 Woodlawn Rd, Long Grove, IA 52756 | 2005-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235744749 | Foot and Ankle Specialists of Ames, LLC | Podiatrist | 1606 S Duff Ave Ste 500, Ames, IA 50010-8156 | 2020-09-11 |
| 1659842045 | Iowa Foot Care Center LLC | Podiatrist | 217 Duff Ave Ste 2, Ames, IA 50010-6609 | 2018-12-10 |
| 1114417078 | Heartland Foot & Ankle Clinic PC | Podiatrist | 2850 Mount Pleasant St Ste 103, Burlington, IA 52601-2002 | 2018-05-16 |
| 1104316108 | Family Foot Care Clinic, PC | Podiatrist | 3200 F Avenue Nw, Cedar Rapids, IA 52405 | 2018-05-15 |
| 1952846321 | Swfac Plc | Podiatrist | 631 N. 8th St., Missouri Valley, IA 51555 | 2016-12-21 |
| 1811367535 | Swfac Plc | Podiatrist | 1101 East 7th Street, Atlantic, IA 50022 | 2015-10-07 |
| 1578946018 | Donald Godfree Jr. | Podiatrist | 3600 30th St Dept Of, Des Moines, IA 50310-5753 | 2015-07-01 |
| 1811303480 | Jennifer Lee Hall | Podiatrist | 5950 University Ave Ste 160, West Des Moines, IA 50266 | 2014-07-03 |
| 1760894323 | Drew Michael Davidson | Podiatrist | 255 Sw Brookside Dr, Ste 200, Grimes, IA 50111-5244 | 2014-05-29 |
| 1609201227 | Patricia A Russo | Podiatrist | 2958 Ingram Ave, Melbourne, IA 50162-9559 | 2013-09-13 |
| Find all providers with the same taxonomy | ||||
| City | LONG GROVE |
| Zip Code | 52756 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.