Mobile Podiatrist, PC
Podiatrist, Primary Podiatric Medicine in Greenwood, IN. Organization (NPI-2).
NPI number1861692402
StatusActive
Last updated in NPPESJun 3, 2011
Details
- NPI
- 1861692402
- Entity type
- Organization (NPI-2)
- Legal business name
- Mobile Podiatrist, PC
- Organization subpart
- No
- Enumeration date
- Jul 23, 2007
- Last updated
- Jun 3, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 213EP1101X | Podiatrist, Primary Podiatric Medicine | 07001009A | IN | Yes |
| 213EP1101X | Podiatrist, Primary Podiatric Medicine | 016-004848 | IL |
Practice location
1558 Victoria CtGreenwood, IN 46143-7884
Phone 317-697-6536 · Fax 317-859-2923
Mailing address
1558 Victoria CtGreenwood, IN 46143-7884
Phone 317-697-6536
Authorized official
Irene Erica Roge
President
3176976536
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