Provider Demographics
NPI:1942492814
Name:HOOSIER FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:HOOSIER FOOT AND ANKLE LLC
Other - Org Name:HOOSIER FOOT AND ANKLE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DEHEER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-346-7722
Mailing Address - Street 1:1159 W JEFFERSON ST STE 204
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2795
Mailing Address - Country:US
Mailing Address - Phone:317-346-7722
Mailing Address - Fax:317-346-7725
Practice Address - Street 1:1159 W JEFFERSON ST STE 204
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2795
Practice Address - Country:US
Practice Address - Phone:317-346-7722
Practice Address - Fax:317-346-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000717213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1912198821OtherNPI SHELBYVILLE IN
IN200450170Medicaid
IN300019586Medicaid
IN1639172034OtherNPI PATRICK A DEHEER DPM
IN1841482940OtherNPI CARMEL IN
IN1003903220OtherNPI COLUMBUS IN OFFICE
IN200450170Medicaid
IN5039910005Medicare NSC