MEDICARE: ROBERT EELLS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	00571	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	028602	OTHER	IA	PRINCIPAL
2	45971	OTHER	IA	WELLMARK BCBS
3	6286A	OTHER	IA	COVENTRY
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790781342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT EELLS DPM

Provider Business Mailing Address
First Line	:	1111 E ARMY POST RD
Second Line	:	SUITE 470
City	:	DES MOINES
State	:	IA
Zip	:	50315-5970
Country	:	US
Telephone Number	:	515-244-0633
Fax Number	:	515-244-2412

Provider Business Practice Location Address
First Line	:	1111 E ARMY POST RD
Second Line	:	SUITE 470
City	:	DES MOINES
State	:	IA
Zip	:	50315-5970
Country	:	US
Telephone Number	:	515-244-0633
Fax Number	:	515-244-2412

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	09/05/2008

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