=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861499402
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA JEANNE HISKES DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2005
-----------------------------------------------------
Last Update Date | 09/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 69 E GARNER RD STE 100
-----------------------------------------------------
City | BROWNSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46112-7699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-852-7511
-----------------------------------------------------
Fax | 317-852-7531
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 69 E GARNER RD STE 100
-----------------------------------------------------
City | BROWNSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46112-7699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-852-7511
-----------------------------------------------------
Fax | 317-852-7531
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 07000712A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------