Provider Demographics
NPI:1417953001
Name:LADINE, MELANIE A (DPM)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:A
Last Name:LADINE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:A
Other - Last Name:RIEGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:8433 HARCOURT RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2196
Mailing Address - Country:US
Mailing Address - Phone:317-887-6736
Mailing Address - Fax:317-876-7370
Practice Address - Street 1:8433 HARCOURT RD
Practice Address - Street 2:SUITE 210
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2190
Practice Address - Country:US
Practice Address - Phone:317-876-7361
Practice Address - Fax:317-876-7370
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN070000950A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200423280Medicaid
INU91345Medicare UPIN
IN480034770Medicare PIN
IN4685310001Medicare NSC
IN6151770001Medicare NSC
IN255740BMedicare PIN
IN480034770Medicare PIN