Healthcare Provider Details

I. General information

NPI: 1164657680
Provider Name (Legal Business Name): LLOYD PODIATRY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13914 STATE ROAD 238 E
FISHERS IN
46037-5506
US

IV. Provider business mailing address

13914 STATE ROAD 238 E
FISHERS IN
46037-5506
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-1381
  • Fax:
Mailing address:
  • Phone: 317-842-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000551A
License Number StateIN

VIII. Authorized Official

Name: LISA LOHREY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 317-336-2106