Provider Demographics
NPI:1457311508
Name:WARNER, TRACY FIALA (DPM)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:FIALA
Last Name:WARNER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 GEORGETOWN RD
Mailing Address - Street 2:STE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5794
Mailing Address - Country:US
Mailing Address - Phone:317-297-0661
Mailing Address - Fax:
Practice Address - Street 1:8101 CLEARVISTA PKWY
Practice Address - Street 2:STE 250
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5605
Practice Address - Country:US
Practice Address - Phone:317-621-3338
Practice Address - Fax:317-621-3333
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000928A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200343750AMedicaid
INU74919Medicare UPIN
521880JMedicare PIN
IN200343750AMedicaid
IN480032351Medicare PIN