Provider Demographics
NPI:1740547769
Name:BARKSDALE, MIEASHA HICKS (DPM)
Entity type:Individual
Prefix:
First Name:MIEASHA
Middle Name:HICKS
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MIEASHA
Other - Middle Name:LYNN
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1769 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1192
Mailing Address - Country:US
Mailing Address - Phone:317-937-8503
Mailing Address - Fax:
Practice Address - Street 1:1769 MELODY LN
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1192
Practice Address - Country:US
Practice Address - Phone:317-937-8503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-15
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001205A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201299790Medicaid