MEDICARE: INDY WOUND CENTER FOR LIMB PRESERVATION & RECONSTRUCTION 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	207R00000X	Internal Medicine Physician
2	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1326763491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDY WOUND CENTER FOR LIMB PRESERVATION & RECONSTRUCTION LLC

Provider Business Mailing Address
First Line	:	8325 S EMERSON AVE STE B1
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-8559
Country	:	US
Telephone Number	:	317-742-6575
Fax Number	:	866-222-7033

Provider Business Practice Location Address
First Line	:	8325 S EMERSON AVE STE B1
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-8559
Country	:	US
Telephone Number	:	317-742-6575
Fax Number	:	866-222-7033

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	NEAL PATEL
Credential	:	DPM
Telephone Number	:	765-618-2792

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	05/11/2023

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