Provider Demographics
NPI:1356302137
Name:WINCKELBACH, J KARL (DPM)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:KARL
Last Name:WINCKELBACH
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 1:33 E COUNTY LINE RD STE B
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1043
Mailing Address - Country:US
Mailing Address - Phone:317-882-9303
Mailing Address - Fax:
Practice Address - Street 1:33 E COUNTY LINE RD
Practice Address - Street 2:STE B
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1043
Practice Address - Country:US
Practice Address - Phone:317-882-9303
Practice Address - Fax:317-882-6605
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000316A213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100047960AMedicaid
IN4691620001Medicare NSC
INT34468Medicare UPIN
IN100047960AMedicaid