Provider Demographics
NPI:1194999680
Name:MARK H SCHLICHTER DPM PC
Entity type:Organization
Organization Name:MARK H SCHLICHTER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHLICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:317-271-0041
Mailing Address - Street 1:7412 ROCKVILLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3070
Mailing Address - Country:US
Mailing Address - Phone:317-271-0041
Mailing Address - Fax:317-271-0148
Practice Address - Street 1:7412 ROCKVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3097
Practice Address - Country:US
Practice Address - Phone:317-271-0041
Practice Address - Fax:317-271-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000358A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100058410AMedicaid
IN066540Medicare Oscar/Certification
0419390001Medicare NSC
INT34506Medicare UPIN