Healthcare Provider Details

I. General information

NPI: 1730363748
Provider Name (Legal Business Name): ACTIVE PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 LAFAYETTE RD
CRAWFORDSVILLE IN
47933-1037
US

IV. Provider business mailing address

1910 LAFAYETTE RD
CRAWFORDSVILLE IN
47933-1037
US

V. Phone/Fax

Practice location:
  • Phone: 765-362-7200
  • Fax: 765-362-4870
Mailing address:
  • Phone: 765-362-7200
  • Fax: 765-362-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000857A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000857A
License Number StateIN

VIII. Authorized Official

Name: DR. YONG S. CHAE
Title or Position: PRESIDENT/OWNER
Credential: D.P.M.
Phone: 765-362-7200