Individual
DR. ROY LIDTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1215 BLAIRS FERRY RD, MARION, IA 52302-3016
(319) 363-8854
(319) 363-0807
Mailing address
1215 BLAIRS FERRY ROAD, MARION, IA 52302
(319) 363-8854
(319) 363-0807
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
555
IA
213E00000X
Podiatrist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6000038C
BCBS
—
Enumeration date
07/07/2005
Last updated
07/08/2007
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