Provider Demographics
NPI:1184730848
Name:PERRY, ANDREW C (DPM)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:PERRY
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 1:2020 UNION ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2694
Mailing Address - Country:US
Mailing Address - Phone:765-449-4758
Mailing Address - Fax:765-449-0659
Practice Address - Street 1:2020 UNION ST STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2694
Practice Address - Country:US
Practice Address - Phone:765-449-4758
Practice Address - Fax:765-449-0659
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000870A213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU73884Medicare UPIN
IN142890BMedicare ID - Type Unspecified