Provider Demographics
NPI:1073263091
Name:CRAIG SHOUSE DPM PC
Entity Type:Organization
Organization Name:CRAIG SHOUSE DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-299-2644
Mailing Address - Street 1:3410 N HIGH SCHOOL RD STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-0002
Mailing Address - Country:US
Mailing Address - Phone:317-299-2644
Mailing Address - Fax:317-328-8914
Practice Address - Street 1:1542 S BLOOMINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2212
Practice Address - Country:US
Practice Address - Phone:317-299-2644
Practice Address - Fax:317-328-8914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAIG SHOUSE DPM PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty