Healthcare Provider Details

I. General information

NPI: 1952309759
Provider Name (Legal Business Name): GEORGE V. TSOUTSOURIS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9105A INDIANAPOLIS BLVD SUITE 102
HIGHLAND IN
46322-2591
US

IV. Provider business mailing address

9105A INDIANAPOLIS BLVD SUITE 102
HIGHLAND IN
46322-2591
US

V. Phone/Fax

Practice location:
  • Phone: 219-923-9090
  • Fax: 219-923-9147
Mailing address:
  • Phone: 219-923-9090
  • Fax: 219-923-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000344
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: