Provider Demographics
NPI:1154924850
Name:NORTHEAST FOOT AND ANKLE LLC
Entity type:Organization
Organization Name:NORTHEAST FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LADINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-876-7361
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:765-335-0119
Mailing Address - Fax:
Practice Address - Street 1:7440 N SHADELAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-0058
Practice Address - Country:US
Practice Address - Phone:317-842-7098
Practice Address - Fax:317-842-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty