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ACTIVE PODIATRY PC NPI 1730363748


NPI Information

NPI: 1730363748
Provider Name: ACTIVE PODIATRY PC
Classification: Podiatrist - 213E00000X
Entity Type: Organization
Address:
3850 SHORE DR STE 301
INDIANAPOLIS, IN
ZIP 46254
Phone: (317) 328-6622
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ACTIVE PODIATRY PC is a podiatrist in Indianapolis, IN. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. ACTIVE PODIATRY PC NPI is 1730363748. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3850 SHORE DR STE 301
INDIANAPOLIS, IN
ZIP 46254-693
Phone: (317) 328-6622
Fax: (317) 290-0094

The provider's authorized official is Yong S. Chae .
The authorized official title is President/owner and has the following contact phone number (317) 245-6223.

The enumeration date for this NPI number is 12/27/2007 and was last updated on 1/27/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1213ES0103XPodiatristFoot & Ankle Surgery07000857AINDIANANo
2213E00000XPodiatrist07000857AINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1000000480680OTHERINDIANAANTHEM /BCBS
2200178610MEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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