| NPI | 1992197925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY COSTELLO CFO 574-647-3460 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery |
| Additional Taxonomies | 213E00000X Podiatrist |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2024-07-22 |