Provider Demographics
NPI:1104467653
Name:INDIANA CHILDREN'S FOOT AND ANKLE CENTER LLC
Entity type:Organization
Organization Name:INDIANA CHILDREN'S FOOT AND ANKLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-346-7722
Mailing Address - Street 1:7412 ROCKVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3098
Mailing Address - Country:US
Mailing Address - Phone:317-346-7722
Mailing Address - Fax:
Practice Address - Street 1:7412 ROCKVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3098
Practice Address - Country:US
Practice Address - Phone:317-346-7722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty