MEDICARE: CARMEL ORTHODESIGN, 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	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922441518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARMEL ORTHODESIGN, LLC

Provider Business Mailing Address
First Line	:	9591 VALPARAISO CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1130
Country	:	US
Telephone Number	:	317-218-4270
Fax Number	:	317-218-4271

Provider Business Practice Location Address
First Line	:	9591 VALPARAISO CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1130
Country	:	US
Telephone Number	:	317-218-4270
Fax Number	:	317-218-4271

Authorized Official
Title or Position	:	SOLE MEMBER / ORTHOTIST
Name	:	MR. DOUGLAS BRYANT HODGE
Credential	:	C.O.
Telephone Number	:	317-407-7049

Provider Enumeration Date	:	04/12/2013
Last Update Date	:	12/13/2016

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Directions to “CARMEL ORTHODESIGN, LLC ” Practice Location

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