Healthcare Provider Details

I. General information

NPI: 1346943735
Provider Name (Legal Business Name): SAMUEL RATHE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PKWY
DENISON IA
51442-2299
US

IV. Provider business mailing address

100 MEDICAL PKWY
DENISON IA
51442-2299
US

V. Phone/Fax

Practice location:
  • Phone: 712-265-2700
  • Fax: 712-854-1130
Mailing address:
  • Phone: 712-265-2700
  • Fax: 712-854-1134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number137142
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: