| NPI | 1912100694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEN KRUEGER Executive Director 317-575-0185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07000857A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07000391A) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2020-08-22 |