Provider Demographics
NPI:1912100694
Name:MERIDIAN FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:MERIDIAN FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-575-0185
Mailing Address - Street 1:3266 N MERIDIAN ST
Mailing Address - Street 2:SUITE 802
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-5846
Mailing Address - Country:US
Mailing Address - Phone:317-927-2455
Mailing Address - Fax:317-927-2092
Practice Address - Street 1:3266 N MERIDIAN ST
Practice Address - Street 2:SUITE 802
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5846
Practice Address - Country:US
Practice Address - Phone:317-927-2455
Practice Address - Fax:317-927-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000857A213E00000X
IN07000391A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU70572Medicare UPIN
IN218100AMedicare ID - Type UnspecifiedMEDICARE NUMBER
INT34522Medicare UPIN
IN236070AMedicare ID - Type UnspecifiedMEDICARE NUMBER