| Organization Name: | PREMIER PODIATRY |
| NPI Number: | 1720445281 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES P LICANDRO (OWNER/PHYSICIAN) |
| Mailing Address: | 405 Woodlawn Rd Long Grove |
| State: | IA US |
| Postal Code: | 527568745 |
| Phone Number: | 5632855446 |
| Fax Number: | 5632855447 |
| NPI Enumeration Date: | 01/28/2016 |
| NPI Last Update Date: | 03/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213E00000X |
| License Number: | 0705 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | 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. |