Healthcare Provider Details

I. General information

NPI: 1295072924
Provider Name (Legal Business Name): CENTRAL INDIANA PODIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13421 OLD MERIDIAN ST STE 202
CARMEL IN
46032-1411
US

IV. Provider business mailing address

6299 GUION RD STE C
INDIANAPOLIS IN
46268-2530
US

V. Phone/Fax

Practice location:
  • Phone: 317-931-0664
  • Fax: 888-510-7211
Mailing address:
  • Phone: 317-931-0664
  • Fax: 317-927-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: SARAH KERANS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 317-931-0664