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Nicola
J
Pike
DPM
Contract Details
Facility name
Provider ID
P000004061
NPI
1225186885
Tax ID
264762525
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
387 7th St
Sioux Center, IA 51250
United States
County
Sioux
Phone
7127224395
(
Phone
)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address