Healthcare Provider Details

I. General information

NPI: 1609860147
Provider Name (Legal Business Name): TODD R HOVERMALE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W 19TH ST
ANDERSON IN
46016-4204
US

IV. Provider business mailing address

PO BOX 2272
ANDERSON IN
46018-2272
US

V. Phone/Fax

Practice location:
  • Phone: 765-649-7351
  • Fax: 765-649-8666
Mailing address:
  • Phone: 765-649-7351
  • Fax: 765-649-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000387
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: