Basic Information
Provider Information
NPI: 1841288586
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEMPEWOLF
FirstName: RODNEY
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: DPM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3178
Address2:  
City: CEDAR RAPIDS
State: IA
PostalCode: 524063178
CountryCode: US
TelephoneNumber: 3193981583
FaxNumber: 3193992085
Practice Location
Address1: 202 10TH STREET SE
Address2:  
City: CEDAR RAPIDS
State: IA
PostalCode: 524032404
CountryCode: US
TelephoneNumber: 3193981545
FaxNumber: 3193982039
Other Information
ProviderEnumerationDate: 10/06/2005
LastUpdateDate: 08/11/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213E00000X00703IAY Podiatric Medicine & Surgery Service ProvidersPodiatrist 

No ID Information.


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