Healthcare Provider Details

I. General information

NPI: 1104467653
Provider Name (Legal Business Name): INDIANA CHILDREN'S FOOT AND ANKLE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 ROCKVILLE RD STE A
INDIANAPOLIS IN
46214-3098
US

IV. Provider business mailing address

7412 ROCKVILLE RD STE A
INDIANAPOLIS IN
46214-3098
US

V. Phone/Fax

Practice location:
  • Phone: 317-346-7722
  • Fax:
Mailing address:
  • Phone: 317-346-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: PATRICK DEHEER
Title or Position: PARTNER
Credential: MD
Phone: 317-346-7722