Provider Demographics
NPI:1518205509
Name:LADINE PODIATRY, PC
Entity Type:Organization
Organization Name:LADINE PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENIAL SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-931-0664
Mailing Address - Street 1:8433 HARCOURT RD STE 210
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2196
Mailing Address - Country:US
Mailing Address - Phone:317-876-7361
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:46260-2196
Practice Address - Country:US
Practice Address - Phone:317-876-7361
Practice Address - Fax:317-876-7370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LADINE PODIATRY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-25
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000950A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDH1868OtherPALMETTO GBA
IN200890330Medicaid
INDH1868OtherPALMETTO GBA