Healthcare Provider Details

I. General information

NPI: 1467847475
Provider Name (Legal Business Name): TRACY LEE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STAFFORD RD STE 145
PLAINFIELD IN
46168-2793
US

IV. Provider business mailing address

5471 GEORGETOWN RD STE C
INDIANAPOLIS IN
46254-5794
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-8866
  • Fax: 317-856-2312
Mailing address:
  • Phone: 317-297-0661
  • Fax: 317-328-6338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001275A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: