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General NPI Number Information
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NPI Number | 1073606935
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Entity Type | Organization
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Legal Business Name | PODIATRY ASSOCIATES OF INDIANA PC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 5471 GEORGETOWN RD STE C
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5794
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Country | US
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Telephone | 317-297-0661
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Fax | 317-328-6338
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Provider Business Mailing Address
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Address Line | 5471 GEORGETOWN RD STE C
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5794
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Country | US
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Telephone | 317-297-0661
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Fax | 317-328-6338
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Authorized Official
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Title or Position | OWNER
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Name | SANDRA C RAYNOR
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Credential | DPM
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Telephone | 317-297-0661
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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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