Healthcare Provider Details

I. General information

NPI: 1093188344
Provider Name (Legal Business Name): INDIANA'S CENTER FOR FOOT AND ANKLE CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 BOLIVAR ST
JEFFERSON CITY MO
65101-1572
US

IV. Provider business mailing address

135 GREEN FOREST DR
CLINTON MS
39056-2235
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-2116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2015013534
License Number StateMO

VIII. Authorized Official

Name: DR. ZIA BARKATULLAH
Title or Position: PRESIDENT AND OWNER
Credential: DPM
Phone: 601-397-5048