Healthcare Provider Details

I. General information

NPI: 1356853873
Provider Name (Legal Business Name): HOOSIER FOOT & ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
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

1159 W JEFFERSON ST STE 204
FRANKLIN IN
46131-2795
US

V. Phone/Fax

Practice location:
  • Phone: 317-271-0041
  • Fax: 317-271-0148
Mailing address:
  • Phone: 317-346-7722
  • Fax: 317-346-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: STELLA SUE DEHEER
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 317-346-7722