Healthcare Provider Details

I. General information

NPI: 1396932695
Provider Name (Legal Business Name): NORTH CENTRAL INDIANA PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1791 W LINCOLN RD
KOKOMO IN
46902-3590
US

IV. Provider business mailing address

1791 W LINCOLN RD
KOKOMO IN
46902-3590
US

V. Phone/Fax

Practice location:
  • Phone: 765-453-7600
  • Fax: 765-453-3861
Mailing address:
  • Phone: 765-453-7600
  • Fax: 765-453-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001003A
License Number StateIN

VIII. Authorized Official

Name: JOSHUA W KEYES
Title or Position: PODIATRIST
Credential:
Phone: 765-453-7600