Dr Jim Paul Licandro, DPM is a
Podiatrist based in Long Grove, Iowa. Dr Jim Paul Licandro is licensed to practice in Iowa (license number 00705) and his current practice location is
405 Woodlawn Rd, Long Grove, Iowa. He can be reached at his office (for appointments etc.) via phone at
(832) 425-7457.
NPI number for Dr Jim Paul Licandro is 1609873538 and his current mailing address is 5261 Boulder Dr Apt D, West Des Moines, Iowa. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1609873538.
Healthcare Provider's Profile
| Full Name | Dr Jim Paul Licandro |
|---|
| Gender | Male |
|---|
| Speciality | Podiatrist |
|---|
| Location | 405 Woodlawn Rd, Long Grove, Iowa |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1609873538
- Provider Enumeration Date: 07/07/2005
- Last Update Date: 07/22/2018
Medical Identifiers
Medical identifiers for Dr Jim Paul Licandro such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1609873538 | NPI | - | NPPES |
| 1197210 | Medicaid | IA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 213E00000X | Podiatrist | 00705 (Iowa) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jim Paul Licandro is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jim Paul Licandro, DPM
5261 Boulder Dr Apt D,
West Des Moines, IA 50265-7823
Ph: (563) 340-4387 | Dr Jim Paul Licandro, DPM
405 Woodlawn Rd,
Long Grove, IA 52756
Ph: (832) 425-7457 |
Reviews and Comments