Provider Demographics
NPI:1760801195
Name:SHOUSE, CRAIG (DPM)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:SHOUSE
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 1:3410 N HIGH SCHOOL RD STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-0002
Mailing Address - Country:US
Mailing Address - Phone:317-299-2644
Mailing Address - Fax:
Practice Address - Street 1:3410 N HIGH SCHOOL RD STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-0002
Practice Address - Country:US
Practice Address - Phone:317-299-2644
Practice Address - Fax:317-328-8914
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001254A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist