MEDICARE: PETER DWIGHT WIRTZ M.D.

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	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	17314	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	:	1689700593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER DWIGHT WIRTZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 355
Second Line	:
City	:	NORWALK
State	:	IA
Zip	:	50211-0355
Country	:	US
Telephone Number	:	515-278-5811
Fax Number	:	515-981-0420

Provider Business Practice Location Address
First Line	:	7601 OFFICE PLAZA DR N
Second Line	:	SUITE 115
City	:	W DES MOINES
State	:	IA
Zip	:	50266-2338
Country	:	US
Telephone Number	:	515-278-5811
Fax Number	:	515-981-0420

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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