Provider Demographics
NPI:1902014301
Name:HARMS, RUSSELL C (DPM)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:C
Last Name:HARMS
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 1:1214 E NATIONAL AVE
Mailing Address - Street 2:SUIT 130
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2700
Mailing Address - Country:US
Mailing Address - Phone:812-448-9290
Mailing Address - Fax:812-448-9296
Practice Address - Street 1:1214 E NATIONAL AVE
Practice Address - Street 2:SUIT 130
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2700
Practice Address - Country:US
Practice Address - Phone:812-448-9290
Practice Address - Fax:812-448-9296
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000207-A213ES0103X
IN07001065A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000601499OtherANTHEM
IN200910370Medicaid
IN200910370Medicaid