Healthcare Provider Details

I. General information

NPI: 1033805130
Provider Name (Legal Business Name): SAMUEL MEMMELAAR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 W US HIGHWAY 18
GARNER IA
50438-1023
US

IV. Provider business mailing address

1316 S MAIN ST
CLARION IA
50525-2019
US

V. Phone/Fax

Practice location:
  • Phone: 844-474-4321
  • Fax: 641-925-1507
Mailing address:
  • Phone: 844-474-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number137532
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: