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General NPI Number Information
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NPI Number | 1952308504
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Entity Type | Individual
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Provider Name | MARK RICHARD HISKES DPM
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Gender | Male
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 69 E GARNER RD STE 100
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City | BROWNSBURG
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State | IN
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Zip | 46112-7699
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Country | US
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Telephone | 317-852-7511
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Fax | 317-852-7531
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Provider Business Mailing Address
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Address Line | 69 E GARNER RD STE 100
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City | BROWNSBURG
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State | IN
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Zip | 46112-7699
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Country | US
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Telephone | 317-852-7511
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Fax | 317-852-7531
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 07000693
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License Number State | IN
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