Provider Demographics
NPI:1093188344
Name:INDIANA'S CENTER FOR FOOT AND ANKLE CARE, P.C.
Entity type:Organization
Organization Name:INDIANA'S CENTER FOR FOOT AND ANKLE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKATULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:601-397-5048
Mailing Address - Street 1:135 GREEN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-2235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 BOLIVAR ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-1572
Practice Address - Country:US
Practice Address - Phone:248-528-2116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015013534310400000X
213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty