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General NPI Number Information
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NPI Number | 1275926347
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Entity Type | Organization
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Legal Business Name | PODIATRIC MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 1501 STATE STREET
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City | LA PORTE
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State | IN
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Zip | 46350-3115
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Country | US
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Telephone | 219-362-5417
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Fax | 219-325-3431
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Provider Business Mailing Address
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Address Line | 1501 STATE ST
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City | LA PORTE
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State | IN
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Zip | 46350-3115
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Country | US
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Telephone | 219-362-5417
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Fax | 219-325-3431
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Authorized Official
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Title or Position | TREASURER
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Name | DR. CHRISTOPHER S GRANDFIELD
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Credential | DPM
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Telephone | 219-362-5417
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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 | IN
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