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General NPI Number Information
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NPI Number | 1043900962
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE CENTERS OF INDIANA LLC
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 239 ASH ST
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City | TIPTON
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State | IN
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Zip | 46072-1752
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Country | US
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Telephone | 765-485-1814
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Fax |
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Provider Business Mailing Address
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Address Line | 239 ASH ST STE B
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City | TIPTON
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State | IN
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Zip | 46072-1752
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Country | US
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Telephone | 765-485-1814
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES VESTILE
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Credential | DPM
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Telephone | 317-441-7981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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