Provider Demographics
NPI:1558818666
Name:WE HEEL THE SOLE PODIATRY LLC
Entity Type:Organization
Organization Name:WE HEEL THE SOLE PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-441-1093
Mailing Address - Street 1:10935 BEECHWOOD DR E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1222
Mailing Address - Country:US
Mailing Address - Phone:317-441-1093
Mailing Address - Fax:317-669-2739
Practice Address - Street 1:1750 MADISON AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6492
Practice Address - Country:US
Practice Address - Phone:317-441-1093
Practice Address - Fax:317-669-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN794213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty