Provider Demographics
NPI:1144284555
Name:ALBRECHT, JULIE KAY (DPM)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:KAY
Last Name:ALBRECHT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:KAY
Other - Last Name:THIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 PENN AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2365
Mailing Address - Country:US
Mailing Address - Phone:515-263-2474
Mailing Address - Fax:515-263-2478
Practice Address - Street 1:1301 PENN AVE
Practice Address - Street 2:STE 213
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2365
Practice Address - Country:US
Practice Address - Phone:515-263-9696
Practice Address - Fax:515-263-0233
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00551213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2110130Medicaid
IA55896Medicare ID - Type Unspecified
IA2110130Medicaid
IA6238790001Medicare NSC
IAIB1410001Medicare PIN