MEDICARE: HOOSIER FOOT & ANKLE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB0934	OTHER		RR MCR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003903220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOOSIER FOOT & ANKLE, LLC

Provider Business Mailing Address
First Line	:	1876 NORTHWOOD PLAZA DRIVE
Second Line	:	BOX 351
City	:	FRANKLIN
State	:	IN
Zip	:	46131
Country	:	US
Telephone Number	:	317-346-7722
Fax Number	:	317-346-7722

Provider Business Practice Location Address
First Line	:	2545 FOX POINTE DR
Second Line	:	SUITE E
City	:	COLUMBUS
State	:	IN
Zip	:	47203-3220
Country	:	US
Telephone Number	:	812-378-3668
Fax Number	:	812-378-5770

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	PATRICK ALLEN DEHEER
Credential	:	DPM
Telephone Number	:	317-346-7722

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	06/08/2009

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Directions to “HOOSIER FOOT & ANKLE, LLC ” Practice Location

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