Healthcare Provider Details

I. General information

NPI: 1992074868
Provider Name (Legal Business Name): AMANDA VUJOVICH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12425 OLD MERIDIAN ST STE A2
CARMEL IN
46032-8725
US

IV. Provider business mailing address

5471 GEORGETOWN RD STE C
INDIANAPOLIS IN
46254-5794
US

V. Phone/Fax

Practice location:
  • Phone: 317-564-0958
  • Fax: 317-564-0961
Mailing address:
  • Phone: 317-297-0661
  • Fax: 317-328-6338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001171A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: