Healthcare Provider Details

I. General information

NPI: 1982791992
Provider Name (Legal Business Name): AMARAD ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 W MAIN ST
PERU IN
46970-1747
US

IV. Provider business mailing address

632 W MAIN ST
PERU IN
46970-1747
US

V. Phone/Fax

Practice location:
  • Phone: 765-473-4220
  • Fax: 765-473-4223
Mailing address:
  • Phone: 765-473-4220
  • Fax: 765-473-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000906A
License Number StateIN

VIII. Authorized Official

Name: DR. BRADLEY R. HAMMERSLEY
Title or Position: OWNER
Credential: DPM
Phone: 765-473-4220