Provider Demographics
NPI:1356853873
Name:HOOSIER FOOT & ANKLE LLC
Entity type:Organization
Organization Name:HOOSIER FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:DEHEER
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:7412 ROCKVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3098
Practice Address - Country:US
Practice Address - Phone:317-271-0041
Practice Address - Fax:317-271-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty