Healthcare Provider Details

I. General information

NPI: 1841482940
Provider Name (Legal Business Name): HOOSIER FOOT & ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 N ILLINOIS ST STE 560
CARMEL IN
46032-3009
US

IV. Provider business mailing address

1876 NORTHWOOD PLAZA DR BOX 351
FRANKLIN IN
46131-2702
US

V. Phone/Fax

Practice location:
  • Phone: 317-346-7722
  • Fax: 317-346-7725
Mailing address:
  • Phone: 317-346-7722
  • Fax: 317-346-7722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000710
License Number StateIN

VIII. Authorized Official

Name: DR. PATRICK ALLEN DEHEER
Title or Position: PODIATRIST
Credential: DPM
Phone: 317-346-7722