MEDICARE: CRAIG SHOUSE DPM PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1104576123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG SHOUSE DPM PC

Provider Business Mailing Address
First Line	:	3410 N HIGH SCHOOL RD STE C
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-0002
Country	:	US
Telephone Number	:	317-299-2644
Fax Number	:	317-328-8914

Provider Business Practice Location Address
First Line	:	8801 N MERIDIAN ST STE 106
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2353
Country	:	US
Telephone Number	:	317-299-2644
Fax Number	:	317-328-8914

Authorized Official
Title or Position	:	OWNER
Name	:	CRAIG SHOUSE
Credential	:	DPM
Telephone Number	:	317-299-2644

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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