Provider Demographics
NPI:1982791992
Name:AMARAD ENTERPRISES, INC.
Entity type:Organization
Organization Name:AMARAD ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMMERSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:765-473-4220
Mailing Address - Street 1:632 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-1747
Mailing Address - Country:US
Mailing Address - Phone:765-473-4220
Mailing Address - Fax:765-473-4223
Practice Address - Street 1:632 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1747
Practice Address - Country:US
Practice Address - Phone:765-473-4220
Practice Address - Fax:765-473-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000906A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000375710OtherANTHEM BLUE CROSS BLUE SH
INP00253559OtherPALMETTO
IN12180OtherPHYSCIAN HEALTH PLAN
IN000000375710OtherANTHEM BLUE CROSS BLUE SH
IN12180OtherPHYSCIAN HEALTH PLAN
INU80007Medicare UPIN