Healthcare Provider Details

I. General information

NPI: 1780846139
Provider Name (Legal Business Name): ACCREDITED FOOT SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9007 INDIANAPOLIS BLVD SUITE B
HIGHLAND IN
46322-2575
US

IV. Provider business mailing address

9007 INDIANAPOLIS BLVD SUITE B
HIGHLAND IN
46322-2575
US

V. Phone/Fax

Practice location:
  • Phone: 219-923-1254
  • Fax: 708-429-5981
Mailing address:
  • Phone: 219-923-1254
  • Fax: 708-429-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number07000534A
License Number StateIN

VIII. Authorized Official

Name: DR. GARY JOHN THOMAS
Title or Position: PROVIDER/OWNER
Credential: DPM
Phone: 219-923-1254