Healthcare Provider Details

I. General information

NPI: 1821402157
Provider Name (Legal Business Name): STEVEN DOUTHETT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2014
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 N CLINTON ST
FORT WAYNE IN
46825-5886
US

IV. Provider business mailing address

5052 N CLINTON ST
FORT WAYNE IN
46825-5822
US

V. Phone/Fax

Practice location:
  • Phone: 260-484-8551
  • Fax: 260-482-5060
Mailing address:
  • Phone: 260-484-8551
  • Fax: 260-482-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3866
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002519
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDP188848
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: