MEDICARE: MR. LARRY JOSEPH DELLWO M.A.

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	231H00000X	Audiologist	132	IA
2	237700000X	Hearing Instrument Specialist	209	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	:	1619036860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY JOSEPH DELLWO M.A.

Provider Business Mailing Address
First Line	:	107 W 5TH ST
Second Line	:
City	:	STORM LAKE
State	:	IA
Zip	:	50588-2343
Country	:	US
Telephone Number	:	712-732-3775
Fax Number	:	712-732-3775

Provider Business Practice Location Address
First Line	:	107 W 5TH ST
Second Line	:
City	:	STORM LAKE
State	:	IA
Zip	:	50588-2343
Country	:	US
Telephone Number	:	712-732-3775
Fax Number	:	712-732-3775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	12/02/2014

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