Healthcare Provider Details

I. General information

NPI: 1790983906
Provider Name (Legal Business Name): LANIE KAY HUFFMAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LANIE KAY WICKHAM DPM

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 GUION ROAD SUITE A
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: 317-924-6241
  • Fax: 317-924-4787
Mailing address:
  • Phone: 317-931-0664
  • Fax: 317-927-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001083A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: