Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JIM PAUL LICANDRO, DPM
DeactivatedDR. JIM PAUL LICANDRO, DPM is a Podiatrist healthcare provider located in LONG GROVE, Iowa. NPI 1609873538 is deactivated in the NPPES registry. Verify at CMS.
Podiatrist · LONG GROVE, IA
This NPI has been deactivated.
The record was deactivated on March 21, 2006.
Deactivated NPIs are no longer valid for billing or credentialing. The provider may have retired, changed practice status, or had their NPI administratively deactivated.
Verify current licensure status with the NPPES NPI Registry or the relevant state medical board before relying on this record.
Registration Details
- NPI Number
- 1609873538
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 7, 2005 (0.7041095890411 yrs)
- Last Updated
- Jul 22, 2018
- Deactivated
- Mar 21, 2006
- License
-
00705 (IA)
Practice Information
- Address
-
405 WOODLAWN RDLONG GROVE, IA, 52756Browse IA providers · Browse ZIP 52756
- Phone
- 8324257457
- Fax
- 5632855446
- Primary Specialty
-
Podiatrist
213E00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.