Provider Demographics
NPI:1174976948
Name:JUSTIN J RAATZ, DPM PLLC
Entity type:Organization
Organization Name:JUSTIN J RAATZ, DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-282-6067
Mailing Address - Street 1:500 E COURT AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2057
Mailing Address - Country:US
Mailing Address - Phone:515-282-6067
Mailing Address - Fax:515-244-1722
Practice Address - Street 1:500 E COURT AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2057
Practice Address - Country:US
Practice Address - Phone:308-660-5407
Practice Address - Fax:515-883-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082885213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty