Provider Demographics
NPI:1033312020
Name:MARK HISKES DPM PC
Entity Type:Organization
Organization Name:MARK HISKES DPM PC
Other - Org Name:GENTLE FAMILY FOOT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:HISKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-852-7511
Mailing Address - Street 1:69 E GARNER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7698
Mailing Address - Country:US
Mailing Address - Phone:317-852-7511
Mailing Address - Fax:317-852-7531
Practice Address - Street 1:69 E GARNER RD
Practice Address - Street 2:STE 100
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7698
Practice Address - Country:US
Practice Address - Phone:317-852-7511
Practice Address - Fax:317-852-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000693213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091435OtherBCBCS
IN100176040Medicaid
CG4527OtherRAILROAD MEDICARE
IN000000091436OtherBCBS
IN100119070Medicaid
IN000000091436OtherBCBS
IN100119070Medicaid
CG4527OtherRAILROAD MEDICARE
IN100176040Medicaid
IN1126630001Medicare NSC