Healthcare Provider Details

I. General information

NPI: 1851399448
Provider Name (Legal Business Name): HOWARD FRED PREUSS JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3684 HIGHWAY 150 SUITE 3
FLOYDS KNOBS IN
47119-9692
US

IV. Provider business mailing address

3684 HIGHWAY 150 SUITE 3
FLOYDS KNOBS IN
47119-9692
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-9837
  • Fax: 812-923-1872
Mailing address:
  • Phone: 812-923-9837
  • Fax: 812-923-1872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00188
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000617A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number00188
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number07000617A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number00188
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number07000617A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00188
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000617A
License Number StateIN
# 9
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100116360A
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 2
Identifier80001886
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: