National Provider Identifier Database

JIM P LICANDRO, DPM – NPI #1609873538
Podiatrist

A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.


Contact Information

JIM P LICANDRO, DPM
405 WOODLAWN RD
LONG GROVE, IA52756
Phone: 832-425-7457
Fax: 563-285-5446
Website:
Specialty Taxonomy Code
* Podiatrist 213E00000X

* Indicates primary specialty

NPI Profile & details for JIM P LICANDRO

NPI Number 1609873538
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 07/07/2005
Last updated 07/22/2018 - About 8 years ago
Sole proprietor1 No
Identifiers
  • IA License #: 00705
  • IA Medicaid: 1197210
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for JIM P LICANDRO, DPM

There are currently no reviews for JIM P LICANDRO, DPM


NPIdb - Home
v2.201