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General NPI Number Information
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NPI Number | 1780846139
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Entity Type | Organization
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Legal Business Name | ACCREDITED FOOT SURGEONS
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 9007 INDIANAPOLIS BLVD SUITE B
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City | HIGHLAND
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State | IN
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Zip | 46322-2575
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Country | US
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Telephone | 219-923-1254
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Fax | 708-429-5981
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Provider Business Mailing Address
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Address Line | 9007 INDIANAPOLIS BLVD SUITE B
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City | HIGHLAND
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State | IN
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Zip | 46322-2575
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Country | US
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Telephone | 219-923-1254
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Fax | 708-429-5981
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | DR. GARY JOHN THOMAS
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Credential | DPM
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Telephone | 219-923-1254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 07000534A
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License Number State | IN
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