Organization
PREMIER PODIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES P LICANDRO DPM (OWNER/PHYSICIAN)
(563) 340-4387
Entity
Organization
Contact information
Practice address
405 WOODLAWN RD, LONG GROVE, IA 52756-8745
(832) 425-7457
(563) 424-7234
Mailing address
PO BOX 2671, DAVENPORT, IA 52809-2671
(832) 425-7457
(563) 285-5447
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0705
IA
Other
Enumeration date
01/28/2016
Last updated
07/21/2022
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