Provider Demographics
NPI:1861690323
Name:KELLY L. KADEL HEARTLAND FOOT CARE
Entity type:Organization
Organization Name:KELLY L. KADEL HEARTLAND FOOT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KADEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:800-448-3011
Mailing Address - Street 1:203 W AGENCY RD STE C
Mailing Address - Street 2:
Mailing Address - City:W BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1676
Mailing Address - Country:US
Mailing Address - Phone:319-753-1883
Mailing Address - Fax:
Practice Address - Street 1:203 W AGENCY RD STE C
Practice Address - Street 2:
Practice Address - City:W BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1676
Practice Address - Country:US
Practice Address - Phone:319-753-1883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0156505Medicaid
IA40741OtherWELLMARK BCBS
IA40741Medicare ID - Type UnspecifiedMEDICARE
IAU67492Medicare UPIN