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General NPI Number Information
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NPI Number | 1154327740
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Entity Type | Individual
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Provider Name | JEFFREY D AGRICOLA DPM
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Gender | Male
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 277 E CARMEL DR STE D
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City | CARMEL
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State | IN
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Zip | 46032-2609
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Country | US
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Telephone | 317-846-4111
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Fax | 317-846-1767
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Provider Business Mailing Address
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Address Line | 3731 GUION ROAD SUITE C
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City | INDIANAPOLIS
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State | IN
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Zip | 46222-7604
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Country | US
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Telephone | 317-931-0661
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Fax | 317-927-0924
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 07000947A
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License Number State | IN
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