Healthcare Provider Details

I. General information

NPI: 1922305564
Provider Name (Legal Business Name): MAJOR FOOT AND ANKLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W RAMPART ST STE 160
SHELBYVILLE IN
46176-8845
US

IV. Provider business mailing address

30 W RAMPART ST SUITE 160
SHELBYVILLE IN
46176-8845
US

V. Phone/Fax

Practice location:
  • Phone: 317-392-0003
  • Fax: 317-398-1859
Mailing address:
  • Phone: 317-392-0003
  • Fax: 317-398-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07001053A
License Number StateIN

VIII. Authorized Official

Name: JOHN HORNER
Title or Position: CEO
Credential:
Phone: 317-392-3211