Organization
DR ROY LIDTKE PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROY LIDTKE MD (MEDICAL DIRECTOR)
(319) 929-5572
Entity
Organization
Contact information
Practice address
1026 A AVE NE, SUITE 5000, CEDAR RAPIDS, IA 52402-5036
(319) 929-5572
Mailing address
PO BOX 284, DES MOINES, IA 50301-0280
(516) 883-7100
(516) 883-7474
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
00555
IA
Other
Enumeration date
09/15/2009
Last updated
09/15/2009
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