1174976948 NPI number — JUSTIN J RAATZ, DPM PLLC

Table of content: (NPI 1174976948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174976948 NPI number — JUSTIN J RAATZ, DPM PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUSTIN J RAATZ, DPM PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174976948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E COURT AVE STE 314
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-282-6067
Provider Business Mailing Address Fax Number:
515-244-1722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 E COURT AVE
Provider Second Line Business Practice Location Address:
SUITE 314
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50309-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-660-5407
Provider Business Practice Location Address Fax Number:
515-883-2692
Provider Enumeration Date:
07/18/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAATZ
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
515-282-6067

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  082885 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)