MEDICARE: DR. MICHAEL STEVEN WORPELL DPM

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	213E00000X	Podiatrist	07000957A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00108081	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000250200	OTHER		ANTHEM ID NUMBER
2	4868080001	OTHER	IN	DMERC

General Provider Information

NPI Number	:	1346247061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL STEVEN WORPELL DPM

Provider Business Mailing Address
First Line	:	1234 E DUPONT RD
Second Line	:	2 1
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1545
Country	:	US
Telephone Number	:	260-416-0070
Fax Number	:	260-416-0017

Provider Business Practice Location Address
First Line	:	1234 E DUPONT RD
Second Line	:	2 1
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1545
Country	:	US
Telephone Number	:	260-416-0070
Fax Number	:	260-416-0017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/25/2008

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