Provider Demographics
NPI:1679768642
Name:GOLDEN CARE PODIATRY
Entity Type:Organization
Organization Name:GOLDEN CARE PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-713-1111
Mailing Address - Street 1:4725 STATESMEN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5645
Mailing Address - Country:US
Mailing Address - Phone:317-713-1100
Mailing Address - Fax:317-713-1100
Practice Address - Street 1:4725 STATESMEN DR
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5645
Practice Address - Country:US
Practice Address - Phone:317-713-1100
Practice Address - Fax:317-713-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100239180Medicaid
IN000000344455OtherANTHEM BLUE CROSS BLUE SHIELD
IN218100Medicare PIN