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General NPI Number Information
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NPI Number | 1104467653
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Entity Type | Organization
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Legal Business Name | INDIANA CHILDREN'S FOOT AND ANKLE CENTER LLC
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 7412 ROCKVILLE RD STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46214-3098
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Country | US
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Telephone | 317-346-7722
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Fax |
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Provider Business Mailing Address
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Address Line | 7412 ROCKVILLE RD STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46214-3098
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Country | US
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Telephone | 317-346-7722
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | PATRICK DEHEER
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Credential | MD
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Telephone | 317-346-7722
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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 |
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License Number State |
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