Healthcare Provider Details

I. General information

NPI: 1982740668
Provider Name (Legal Business Name): MARK C RINDLISBACHER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 HIGHLAND VILLAGE DR
MISHAWAKA IN
46545-7150
US

IV. Provider business mailing address

1121 HIGHLAND VILLAGE DR
MISHAWAKA IN
46545-7150
US

V. Phone/Fax

Practice location:
  • Phone: 907-250-0916
  • Fax:
Mailing address:
  • Phone: 907-250-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number3430
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number07001453A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: