Healthcare Provider Details

I. General information

NPI: 1154838498
Provider Name (Legal Business Name): KATHLEEN TOEPP NEUHOFF, DPM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E JEFFERSON BLVD
SOUTH BEND IN
46617-2902
US

IV. Provider business mailing address

727 E JEFFERSON BLVD
SOUTH BEND IN
46617-2902
US

V. Phone/Fax

Practice location:
  • Phone: 574-287-5859
  • Fax: 574-287-4987
Mailing address:
  • Phone: 574-287-5859
  • Fax: 574-287-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000788
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000788
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number07000788
License Number StateIN

VIII. Authorized Official

Name: KATHLEEN TOEPP NEUHOFF
Title or Position: SOLE OWNER
Credential: DOM
Phone: 574-287-5859