DR. JIM PAUL LICANDRO DPM
NPI 1609873538
Podiatrist in Long Grove, IA

Q: What is Jim Licandro's NPI number?

The NPI number for Jim Licandro is 1609873538. It was assigned to this individual provider in the NPPES registry on July 7, 2005. The provider is also known as Dr. James Paul Licandro Dpm.

Q: What is Jim Licandro's specialty?

The primary specialty registered for this NPI is Podiatrist with taxonomy code 213E00000X.

Q: When was this NPI record last updated?

The NPPES record for Jim Licandro was last updated on July 22, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 07, 2005

405 WOODLAWN RD, LONG GROVE, IA 52756(832) 425-7457(563) 285-5446 Get Directions Write a Review

NPPES record last updated: July 22, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 22, 2018, Jul 13, 2017 (2 updates tracked since 2017).

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About Dr. Jim Paul Licandro Dpm NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JIM PAUL LICANDRO DPM (NPI 1609873538) is an individual podiatrist in Long Grove, Iowa, licensed in Iowa (00705) and active in the NPI registry since July 2005.

NPPES Registry Identity

NPI1609873538

Entity TypeIndividualMale

Primary Taxonomy213E00000X

Provider Legal NameDR. JIM PAUL LICANDROCredential: DPM

Location Address405 WOODLAWN RDLong Grove, IA 52756

Mailing Address5261 Boulder Dr Apt DWest Des Moines, IA 50265-7823 · (563) 340-4387 · Fax (563) 424-7234

Phone(832) 425-7457

Fax(563) 285-5446

Sole ProprietorNo

Enumeration DateJuly 7, 2005

Last NPPES UpdateJuly 22, 20182 updates tracked since enumeration

✔ NPI 1609873538 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatristPodiatric Medicine & Surgery Service Providers

Taxonomy Code213E00000X

License✔ Licensed in IA · 00705

Definition

A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

405 WOODLAWN RD, Long Grove, IA 52756

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Other Names 1

Other Name (5)Dr. James Paul Licandro Dpm

Other Identifiers 1

Medicaid1197210IA

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PREMIER PODIATRY

Podiatrist

405 WOODLAWN RD
LONG GROVE, IA 52756

Scott County (832) 425-7457

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jim Licandro's NPI number?

The NPI number for Jim Licandro is 1609873538. It was assigned to this individual provider in the NPPES registry on July 7, 2005. The provider is also known as Dr. James Paul Licandro Dpm.

Where is Jim Licandro located?

Jim Licandro practices at 405 Woodlawn Rd, Long Grove, IA 52756. The listed phone number is (832) 425-7457.

What is Jim Licandro's specialty?

The primary specialty registered for this NPI is Podiatrist with taxonomy code 213E00000X.

When was this NPI record last updated?

The NPPES record for Jim Licandro was last updated on July 22, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.