Provider Demographics
NPI:1154613636
Name:CHRISTIE, DREW HEISTEN (DPM)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:HEISTEN
Last Name:CHRISTIE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7671 BALLYSHANNON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-7416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 FRY RD
Practice Address - Street 2:STE. A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-2410
Practice Address - Country:US
Practice Address - Phone:317-881-0788
Practice Address - Fax:317-889-0775
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001177A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1002540001Medicare NSC
IN591000001Medicare PIN