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General NPI Number Information
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NPI Number | 1033312020
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Entity Type | Organization
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Legal Business Name | MARK HISKES DPM PC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 69 E GARNER RD STE 100
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City | BROWNSBURG
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State | IN
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Zip | 46112-7698
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Country | US
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Telephone | 317-852-7511
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Fax | 317-852-7531
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Provider Business Mailing Address
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Address Line | 69 E GARNER RD STE 100
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City | BROWNSBURG
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State | IN
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Zip | 46112-7698
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Country | US
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Telephone | 317-852-7511
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Fax | 317-852-7531
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Authorized Official
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Title or Position | OWNER
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Name | MARK R HISKES
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Credential |
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Telephone | 317-852-7511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07000693
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License Number State | IN
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