Healthcare Provider Details

I. General information

NPI: 1972585693
Provider Name (Legal Business Name): JEFFREY T. BIEVER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53880 CARMICHAEL DR
SOUTH BEND IN
46635-1567
US

IV. Provider business mailing address

3600 W BETHEL AVE
MUNCIE IN
47304-5407
US

V. Phone/Fax

Practice location:
  • Phone: 574-247-9441
  • Fax: 574-247-9442
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000961A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: