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General NPI Number Information
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NPI Number | 1457732133
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Entity Type | Organization
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Legal Business Name | ANGELIC FOOTCARE
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Dates
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Enumeration Date | 06/17/2015
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 8785 KEYSTONE XING 1268
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-2337
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Country | US
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Telephone | 317-397-1718
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Fax |
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Provider Business Mailing Address
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Address Line | 8785 KEYSTONE XING 1268
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-2337
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Country | US
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Telephone | 317-397-1718
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. TANISHA SMITH
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Credential | DPM
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Telephone | 317-397-1718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 07001108A
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License Number State | IN
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