Organization
AREA WIDE FOOT & ANKLE CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIM PAUL LICANDRO D.P.M. (OWNER)
(563) 441-0117
Entity
Organization
Contact information
Practice address
1967 SPRUCE HILLS DR, BETTENDORF, IA 52722-2624
(563) 441-0117
(563) 355-7396
Mailing address
1967 SPRUCE HILLS DR, BETTENDORF, IA 52722-2624
(563) 441-0117
(563) 355-7396
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
00705
IA
261QP1100X
Podiatric Clinic/Center
Primary
00705
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1197210
—
IA
Enumeration date
02/08/2008
Last updated
03/08/2008
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