Healthcare Provider Details

I. General information

NPI: 1528040714
Provider Name (Legal Business Name): DARIN RICHARD SERLETIC DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 W 5TH ST
JASPER IN
47546-3172
US

IV. Provider business mailing address

645 W 5TH ST
JASPER IN
47546-3172
US

V. Phone/Fax

Practice location:
  • Phone: 812-634-2778
  • Fax: 812-634-2909
Mailing address:
  • Phone: 812-634-2778
  • Fax: 812-634-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000795A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000795A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: