Provider Demographics
NPI:1689088783
Name:RINDLISBACHER, ERIC (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:RINDLISBACHER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 CEDAR ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3421 CASSOPOLIS STREET STE 200
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-6774
Practice Address - Country:US
Practice Address - Phone:574-335-8180
Practice Address - Fax:574-335-0842
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000315213ES0103X
IN07001262A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1102471397OtherANTHEM
IN300006095Medicaid