MEDICARE: PROFESSIONAL FOOT AND ANKLE CARE INC PC

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	00600	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104119189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL FOOT AND ANKLE CARE INC PC

Provider Business Mailing Address
First Line	:	805 S GILBERT ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-1742
Country	:	US
Telephone Number	:	319-337-2021
Fax Number	:	319-337-8411

Provider Business Practice Location Address
First Line	:	805 S GILBERT ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-1742
Country	:	US
Telephone Number	:	319-337-2021
Fax Number	:	319-337-8411

Authorized Official
Title or Position	:	DPM
Name	:	DR. GEORGE S. SEHL
Credential	:
Telephone Number	:	319-337-2021

Provider Enumeration Date	:	05/24/2011
Last Update Date	:	08/26/2011

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