Healthcare Provider Details

I. General information

NPI: 1659626265
Provider Name (Legal Business Name): AT HOME PODIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9011 N MERIDIAN ST SUITE 204
INDIANAPOLIS IN
46260-5378
US

IV. Provider business mailing address

9011 N MERIDIAN ST SUITE 204
INDIANAPOLIS IN
46260-5378
US

V. Phone/Fax

Practice location:
  • Phone: 317-847-1558
  • Fax:
Mailing address:
  • Phone: 317-218-4095
  • Fax: 877-476-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD MANN
Title or Position: OWNER/PODIATRIST
Credential: DPM
Phone: 317-847-1558