1396039996 NPI number — INDIANA CENTER FOR FOOT AND ANKLE CARE, PC

Table of content: (NPI 1396039996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396039996 NPI number — INDIANA CENTER FOR FOOT AND ANKLE CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIANA CENTER FOR FOOT AND ANKLE CARE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396039996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9465 COUNSELORS ROW
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46240-6423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-578-4043
Provider Business Practice Location Address Fax Number:
888-524-7464
Provider Enumeration Date:
06/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BARKATULLAH
Authorized Official First Name:
ZIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, PODIATRIST
Authorized Official Telephone Number:
601-826-7460

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  07000992A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1558345975 . This is a "NOT SURE, A PREVIOUS JOB OBTAINED THIS FOR ME" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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