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General NPI Number Information
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NPI Number | 1053436782
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Entity Type | Organization
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Legal Business Name | COLUMBUS FOOT AND ANKLE CLINIC, PC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 360 PLAZA DRIVE SUITE B
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City | COLUMBUS
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State | IN
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Zip | 47201-2960
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Country | US
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Telephone | 812-372-6274
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Fax | 812-372-9357
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Provider Business Mailing Address
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Address Line | 360 PLAZA DR SUITE B
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City | COLUMBUS
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State | IN
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Zip | 47201-2960
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Country | US
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Telephone | 812-372-6274
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Fax | 812-372-9357
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN RICHARD HLADIK
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Credential | DPM
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Telephone | 812-372-6274
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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 | 07000873
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License Number State | IN
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