MEDICARE: IOWA FOOT & ANKLE CENTER, 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	00490	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
2	DE1998	OTHER	IA	RRM

General Provider Information

NPI Number	:	1275661795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOWA FOOT & ANKLE CENTER, PC

Provider Business Mailing Address
First Line	:	2903 NORTHGATE DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-9571
Country	:	US
Telephone Number	:	319-351-1100
Fax Number	:	319-351-2669

Provider Business Practice Location Address
First Line	:	2903 NORTHGATE DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-9571
Country	:	US
Telephone Number	:	319-351-1100
Fax Number	:	319-351-2669

Authorized Official
Title or Position	:	PODIATRIST
Name	:	CHESTER A. PELSANG III
Credential	:	DPM
Telephone Number	:	319-351-1100

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	03/13/2008

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