Provider Demographics
NPI:1841482940
Name:HOOSIER FOOT & ANKLE LLC
Entity type:Organization
Organization Name:HOOSIER FOOT & ANKLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DEHEER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-346-7722
Mailing Address - Street 1:1876 NORTHWOOD PLAZA DR
Mailing Address - Street 2:BOX 351
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2702
Mailing Address - Country:US
Mailing Address - Phone:317-346-7722
Mailing Address - Fax:317-346-7722
Practice Address - Street 1:11725 N ILLINOIS ST STE 560
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3009
Practice Address - Country:US
Practice Address - Phone:317-346-7722
Practice Address - Fax:317-346-7725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOOSIER FOOT AND ANKLE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000710213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200450170Medicaid
IN200450170Medicaid
IN5039910006Medicare NSC
IN210070AMedicare PIN