Healthcare Provider Details

I. General information

NPI: 1437398310
Provider Name (Legal Business Name): MATTHEW HABECKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST PROSTHETICS 121
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

1481 WEST 10TH STREET PROSTHETICS 121
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-3722
  • Fax:
Mailing address:
  • Phone: 317-988-3722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: