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General NPI Number Information
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NPI Number | 1285837773
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Entity Type | Organization
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Legal Business Name | BEECH GROVE FOOT CARE INC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 7855 S. EMERSON AVE SUITE T
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City | INDIANAPOLIS
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State | IN
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Zip | 46237
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Country | US
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Telephone | 317-300-0106
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Fax | 317-497-8383
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Provider Business Mailing Address
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Address Line | 7855 S EMERSON AVE SUITE T
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-8668
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Country | US
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Telephone | 317-300-0106
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Fax | 317-497-8383
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Authorized Official
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Title or Position | DOCTOR
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Name | JEFFREY S STEVENS
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Credential | D.P.M.
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Telephone | 317-300-0106
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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 | 07000694A
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License Number State | IN
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