Basic Information
| Provider Information | |||||||||
| NPI: | 1174976948 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JUSTIN J RAATZ, DPM PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E COURT AVE STE 314 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503092057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152826067 | ||||||||
| FaxNumber: | 5152441722 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 E COURT AVE | ||||||||
| Address2: | SUITE 314 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503092057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3086605407 | ||||||||
| FaxNumber: | 5158832692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2016 | ||||||||
| LastUpdateDate: | 12/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | RAATZ | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5152826067 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 082885 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.