MEDICARE: ELVIS TAKO DPM

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	POD305039	GA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	07001512A	IN
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1689248916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVIS TAKO DPM

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9650 E WASHINGTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-3032
Country	:	US
Telephone Number	:	317-890-5500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	03/02/2026

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Directions to “ ELVIS TAKO DPM” Practice Location

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