Provider Demographics
NPI:1982744215
Name:WABASH VALLEY PODIATRY INC.
Entity Type:Organization
Organization Name:WABASH VALLEY PODIATRY INC.
Other - Org Name:GERALD HENKE DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF WABASH VALLEY PODIATRY
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-235-9980
Mailing Address - Street 1:1543 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-1610
Mailing Address - Country:US
Mailing Address - Phone:812-235-9980
Mailing Address - Fax:812-234-7334
Practice Address - Street 1:1543 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-1610
Practice Address - Country:US
Practice Address - Phone:812-235-9980
Practice Address - Fax:812-234-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000314A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0514070001OtherDEMERC
INI002373OtherCHAMPUS
INI002373OtherCHAMPUS
IN853680Medicare ID - Type Unspecified