Provider Demographics
NPI:1255547550
Name:ADVANCED CENTER FOR THE EVALUATION OF FOOT AND ANKLE PAIN LLC
Entity type:Organization
Organization Name:ADVANCED CENTER FOR THE EVALUATION OF FOOT AND ANKLE PAIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ZUNICA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-841-9930
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-0147
Mailing Address - Country:US
Mailing Address - Phone:317-841-9930
Mailing Address - Fax:317-815-8505
Practice Address - Street 1:6296 RUCKER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4852
Practice Address - Country:US
Practice Address - Phone:317-841-9930
Practice Address - Fax:317-815-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000610A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200350690Medicaid
IN200350690Medicaid
IN183800Medicare PIN