Peter Dwight Wirtz, M.D.
Individual provider Active NPI Adult Reconstructive Orthopaedic Surgery Physician · W Des Moines, IA
NPI 1689700593 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1689700593
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X
- License
- 17314 (IA)
- Practice address
- 7601 Office Plaza Dr N
Suite 115
W Des Moines, IA 50266-2338 - Phone
- (515) 278-5811
- Fax
- (515) 981-0420
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01975 | IA | MD | Social Worker |
| 17314 | IA | MD | Adult Reconstructive Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stadia Sports Medicine PC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Reconstructive Orthopaedic Surgery Physician | 207XS0114X | 17314 | IA | Yes |
Addresses
Primary practice location
7601 Office Plaza Dr N
Suite 115
W Des Moines, IA 50266-2338
Mailing address
PO Box 355
Norwalk, IA 50211-0355
Phone (515) 278-5811
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0030767 | Medicaid | IA |
Other providers in W Des Moines, IA
All providers in W Des Moines, IA · Adult Reconstructive Orthopaedic Surgery Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.