MEDICARE: INDIANA CENTER FOR FOOT AND ANKLE CARE, PC

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	213E00000X	Podiatrist	07000992A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558345975	OTHER	IN	NOT SURE, A PREVIOUS JOB OBTAINED THIS FOR ME

General Provider Information

NPI Number	:	1396039996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA CENTER FOR FOOT AND ANKLE CARE, PC

Provider Business Mailing Address
First Line	:	9465 COUNSELORS ROW
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-6423
Country	:	US
Telephone Number	:	800-578-4043
Fax Number	:	888-524-7464

Provider Business Practice Location Address
First Line	:	9465 COUNSELORS ROW
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-6423
Country	:	US
Telephone Number	:	800-578-4043
Fax Number	:	888-524-7464

Authorized Official
Title or Position	:	OWNER, PODIATRIST
Name	:	DR. ZIA BARKATULLAH
Credential	:	DPM
Telephone Number	:	601-826-7460

Provider Enumeration Date	:	06/01/2011
Last Update Date	:	06/14/2011

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