=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114318920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EIFLER'S ELKHART PODIATRY CLINIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2015
-----------------------------------------------------
Last Update Date | 07/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1723 E BRISTOL ST
-----------------------------------------------------
City | ELKHART
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46514-3968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-264-7180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1723 E BRISTOL ST
-----------------------------------------------------
City | ELKHART
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46514-3968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-264-7180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIC SURGEON
-----------------------------------------------------
Name | DR. JEFFREY EIFLER
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 269-655-5568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 07001198A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------