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General NPI Number Information
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NPI Number | 1356521504
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Entity Type | Organization
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Legal Business Name | SOUTHEAST IOWA ORTHOPEDICS & SPORTS MEDICINE PC
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 903 OAK ST
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City | BURLINGTON
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State | IA
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Zip | 52601-4608
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Country | US
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Telephone | 319-758-9133
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Fax | 319-758-9143
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Provider Business Mailing Address
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Address Line | PO BOX 156
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City | BURLINGTON
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State | IA
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Zip | 52601-0156
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Country | US
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Telephone | 319-758-9133
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Fax | 319-758-9143
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL W HENDRICKS
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Credential | MD
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Telephone | 319-758-9133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 26178
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License Number State | IA
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