Basic Information
| Provider Information | |||||||||
| NPI: | 1306175104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAATZ | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M | ||||||||
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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 STE 314 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503092057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152826067 | ||||||||
| FaxNumber: | 5152441722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2009 | ||||||||
| LastUpdateDate: | 12/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 329 | NE | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0131X | 082885 | IA | N | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213ES0103X | 082885 | IA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | 2009017428 | MO | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.