Provider Demographics
NPI:1700889102
Name:OFFUTT, STEPHEN M (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:OFFUTT
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 1:8780 PURDUE RD
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6129
Mailing Address - Country:US
Mailing Address - Phone:317-471-8701
Mailing Address - Fax:317-471-8702
Practice Address - Street 1:8780 PURDUE RD
Practice Address - Street 2:SUITE # 7
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-6129
Practice Address - Country:US
Practice Address - Phone:317-471-8701
Practice Address - Fax:317-471-8702
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0700991A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01287668OtherRAILROAD MEDICARE
IN07000991AOtherSTATE LICENSE
IN200958540Medicaid
IN11267445OtherCAQH
IN200268880EMedicaid
IN07000991BOtherSTATE DEA
IN200268880EMedicaid
IN11267445OtherCAQH
IN859800002Medicare PIN
IN200958540Medicaid