Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 00681 | IA |
Y | 222Z00000X | Podiatrist | 00681 | IA |
N | 213ES0103X | Foot & Ankle Surgery | 00681 | IA |
NPI | 1053329094 |
---|---|
Provider Name | Dr. Andrew Christian Stanislav |
First Address | Glenwood, IA 51534-1260 |
Second Address | Red Oak, IA 51566-2350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 15/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0429761 | (05) | IA |
1185355 | (05) | IA |
U76574 | (02) | IA |