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General NPI Number Information
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NPI Number | 1700926011
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Entity Type | Organization
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Legal Business Name | UTLEY CLINICS INC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 720 S 6TH ST
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City | MONTICELLO
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State | IN
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Zip | 47960-8182
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Country | US
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Telephone | 765-296-9842
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Fax | 765-296-9842
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Provider Business Mailing Address
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Address Line | 761 N 900 E
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City | LAFAYETTE
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State | IN
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Zip | 47905-7569
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Country | US
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Telephone | 765-296-9842
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Fax | 765-296-9842
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CYNTHIA LYNN UTLEY-BRENEMAN
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Credential | D.P.M.
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Telephone | 765-296-9842
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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 | 07000682A
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License Number State | IN
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