Provider Demographics
NPI:1962519330
Name:STEVENS, JEFFREY S (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:STEVENS
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 1:7855 S EMERSON AE STET
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8669
Mailing Address - Country:US
Mailing Address - Phone:317-300-0106
Mailing Address - Fax:317-497-8383
Practice Address - Street 1:7855 S EMERSON AVE
Practice Address - Street 2:SUITE T
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8668
Practice Address - Country:US
Practice Address - Phone:317-300-0106
Practice Address - Fax:317-497-8383
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000694213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN480019149OtherMEDICARE RR PROV#
IN100130870Medicaid
IN87821OtherBCBS/ANTHEM PROV #
IN87821OtherBCBS/ANTHEM PROV #
IN100130870Medicaid
IN480019149OtherMEDICARE RR PROV#