Healthcare Provider Details

I. General information

NPI: 1225526676
Provider Name (Legal Business Name): JOSEPH J CANDELA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W BASSETT RD STE 4
SHELBYVILLE IN
46176-8575
US

IV. Provider business mailing address

30 W RAMPART ST STE 200
SHELBYVILLE IN
46176-8846
US

V. Phone/Fax

Practice location:
  • Phone: 317-421-2663
  • Fax:
Mailing address:
  • Phone: 317-421-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001359A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number99086878A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: