=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174658280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDIANA PODIATRY GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 10/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7430 N SHADELAND AVE SUITE 290
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46250-2070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-841-7990
-----------------------------------------------------
Fax | 317-841-8253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7301 E 90TH ST SUITE 112
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46256-7206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-565-1411
-----------------------------------------------------
Fax | 317-773-2226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES OWNER
-----------------------------------------------------
Name | SCOTT L SCHULMAN
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 317-841-7990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 07000701A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------