DR. JOHN CHARLES REDENIUS (NPI# 1649285073) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649285073 |
| Entity Type | Individual |
| Full Name | DR. JOHN CHARLES REDENIUS |
| Other Name | BLACK HAWK PODIATRY |
| Credential | DPM |
| Practice Address |
123 Plaza Circle Waterloo IA 50701-5197 |
| Practice Telephone | 3192360564 |
| Practice Fax Number | 3192360564 |
| Mailing Telephone | 3192360564 |
| Mailing Fax Number | 3192360564 |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-12-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 322 | IA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0148932 | 05 |
| Street Address |
123 PLAZA CIRCLE |
| City | WATERLOO |
| State | IA |
| Zip Code | 50701-5197 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548757586 | Shawna Harvey | Optometrist | 999 Home Plz Ste 100, Waterloo, IA 50701 | 2018-04-16 |
| 1831693290 | Blue Gregory Boyer | Counselor | 3362 University Ave., Waterloo, IA 50701 | 2018-03-21 |
| 1518460666 | Tom Taylor | Specialist | 974 Home Plaza, Waterloo, IA 50701 | 2018-03-15 |
| 1194247551 | Homelink Sanford | Durable Medical Equipment & Medical Supplies | 1111 W San Marnan Drive, Waterloo, IA 50701 | 2017-07-07 |
| 1932471109 | Walgreens | Pharmacy | 111 W Ridgeway Avenue, Waterloo, IA 50701 | 2012-02-03 |
| 1598055188 | Knox Eyecare | Optometrist | 1030 Alabar Ave., Waterloo, IA 50701 | 2011-04-15 |
| 1013222330 | Ashley Lynn Charmichael | Dentist | 220 W. Ridgeway Ave., Suite 201, Waterloo, IA 50701 | 2010-08-11 |
| 1396062311 | Gwendoline Fang | Obstetrics & Gynecology | 1015 S. Hackett Road Suite 200, Department of Ob/gyn, Waterloo, IA 50701 | 2010-04-29 |
| 1013234194 | Ryan Norman Borgwardt | Dentist | 820 Fisher Drive, Waterloo, IA 50701 | 2010-04-28 |
| 1629302310 | Rhonda Kay Herum | Social Worker | 3731 Pheasant Lane #203, Waterloo, IA 50701 | 2009-09-28 |
| Find all providers in zip 50701 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134384902 | Benjamin Harrison Davidson | Pediatrics | 2710 Saint Francis Dr., Suite 510, Waterloo, IA 50702 | 2008-07-22 |
| 1508846007 | Angela S Townsend | Pediatrics | 2710 Saint Francis Drive Suite 510, Waterloo, IA 50702-5620 | 2006-01-19 |
| 1831174663 | Daniel Wright | Pediatrics | 2710 Saint Francis Dr Ste 510, Waterloo, IA 50702-5620 | 2005-12-14 |
| 1932101532 | Kenneth D Hawn | Pediatrics | 509 Hamacher St, Suite 103, Waterloo, IL 62298-1592 | 2005-08-12 |
| 1013313576 | Rajani Uppala | Pediatrics | 905 Franklin St, Waterloo, IA 50703-4407 | 2014-11-11 |
| 1467892042 | Kendra L Elwood | Pediatrics | 2710 Saint Francis Dr Ste 510, Waterloo, IA 50702-5620 | 2013-06-27 |
| 1922390988 | Humam Samir Alabsi | Pediatrics | 905 Franklin St, Waterloo, IA 50703-4407 | 2011-05-10 |
| 1497911838 | Mary Kathryn Bowen | Pediatrics | 905 Franklin St, Waterloo, IA 50703-4407 | 2008-08-05 |
| 1710145115 | Erica Nichole Leclair | Pediatrics | 3421 W 9th St, Waterloo, IA 50702-5401 | 2008-06-02 |
| 1649336538 | Deborah Fedge II | Pediatrics | 905 Franklin St, Waterloo, IA 50703-4407 | 2006-12-28 |
| Find all providers in WATERLOO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.