Healthcare Provider Details

I. General information

NPI: 1659366029
Provider Name (Legal Business Name): NORTHERN INDIANA FOOT & ANKLE ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 COLONIAL COURT
PLYMOUTH IN
46563-1860
US

IV. Provider business mailing address

504 COLONIAL CT
PLYMOUTH IN
46563-1860
US

V. Phone/Fax

Practice location:
  • Phone: 574-935-5563
  • Fax: 574-935-0015
Mailing address:
  • Phone: 574-935-5563
  • Fax: 574-935-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARCI A ZIELINSKI
Title or Position: MANAGER
Credential:
Phone: 574-935-5563