Provider Demographics
NPI:1225034028
Name:RHODES, SEAN MICHAEL (DPM)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:MICHAEL
Last Name:RHODES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 PROVIDENT CT. SUITE B
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580
Mailing Address - Country:US
Mailing Address - Phone:574-269-9200
Mailing Address - Fax:574-269-9658
Practice Address - Street 1:2280 PROVIDENT CT STE B
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3284
Practice Address - Country:US
Practice Address - Phone:574-269-9200
Practice Address - Fax:574-269-9658
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000846213ES0103X, 213ES0131X, 213E00000X, 213EP1101X, 213EP0504X, 213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000108914OtherBLUE CROSS BLUE SHIELD
IN200158810BMedicaid
IN4247340001Medicare NSC
IN200158810BMedicaid
IN151750Medicare ID - Type Unspecified
IN151750Medicare PIN