MEDICARE: RUSSELL HARMS DPM 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	213ES0103X	Foot & Ankle Surgery Podiatrist	07001065	IN

General Provider Information

NPI Number	:	1831422195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSSELL HARMS DPM PC

Provider Business Mailing Address
First Line	:	1214 E NATIONAL AVE
Second Line	:	SUITE 90B
City	:	BRAZIL
State	:	IN
Zip	:	47834-2700
Country	:	US
Telephone Number	:	812-448-9290
Fax Number	:	812-448-9296

Provider Business Practice Location Address
First Line	:	1024 S 6TH ST
Second Line	:	SUITE 102
City	:	TERRE HAUTE
State	:	IN
Zip	:	47807-5015
Country	:	US
Telephone Number	:	812-232-3338
Fax Number	:	812-234-8828

Authorized Official
Title or Position	:	OWNER
Name	:	RUSSELL C HARMS
Credential	:	DPM
Telephone Number	:	812-448-9290

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	09/17/2009

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