Provider Demographics
NPI:1760679369
Name:LADINE PODIATRY PC
Entity Type:Organization
Organization Name:LADINE PODIATRY PC
Other - Org Name:NEW CASTLE FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIELS
Authorized Official - Middle Name:W
Authorized Official - Last Name:LADINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:765-529-5300
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 STE 210
Practice Address - Street 2:
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000966A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200890330Medicaid
INDH1868Medicare PIN
IN255740Medicare PIN
IN6151770001Medicare NSC
INU95678Medicare UPIN