Healthcare Provider Details

I. General information

NPI: 1841235512
Provider Name (Legal Business Name): CENTRAL INDIANA PODIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 GUION RD STE C
INDIANAPOLIS IN
46222-7604
US

IV. Provider business mailing address

3731 GUION ROAD SUITE C
INDIANAPOLIS IN
46222-7604
US

V. Phone/Fax

Practice location:
  • Phone: 317-931-0664
  • Fax: 317-927-0924
Mailing address:
  • Phone: 317-931-0664
  • Fax: 317-927-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000416A
License Number StateIN

VIII. Authorized Official

Name: DR. ANTHONY E MILLER
Title or Position: OWNER
Credential: D.P.M.
Phone: 317-927-7000