Healthcare Provider Details

I. General information

NPI: 1780093765
Provider Name (Legal Business Name): ANDREW KAPSALIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8607 E US HIGHWAY 36 STE 100
AVON IN
46123-7960
US

IV. Provider business mailing address

8607 E US HIGHWAY 36 STE 100
AVON IN
46123-7960
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-5403
  • Fax:
Mailing address:
  • Phone: 317-745-5403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number135000862
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001248A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07001248A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: