Provider Demographics
NPI:1174658280
Name:INDIANA PODIATRY GROUP INC
Entity Type:Organization
Organization Name:INDIANA PODIATRY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-841-7990
Mailing Address - Street 1:7301 E 90TH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-7206
Mailing Address - Country:US
Mailing Address - Phone:317-565-1411
Mailing Address - Fax:317-773-2226
Practice Address - Street 1:7430 N SHADELAND AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2070
Practice Address - Country:US
Practice Address - Phone:317-841-7990
Practice Address - Fax:317-841-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000701A213E00000X
213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200009840Medicaid
IN0430490001Medicare NSC
IN200009840Medicaid