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Organization
PODIATRIC MEDICAL ASSOCIATES PC
Active
Organization
PODIATRIC MEDICAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN K GRANDFIELD DPM (PRESIDENT)
(219) 763-2008
Entity
Organization
Contact information
Practice address
6289 CENTRAL AVE, PORTAGE, IN 46368-3725
(219) 763-2008
(219) 762-2291
Mailing address
6289 CENTRAL AVE, PORTAGE, IN 46368-3725
(219) 763-2008
(219) 762-2291
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100907960
—
IN
05
—
200326020
—
IN
01
—
492470
RR MEDICARE
IN
Enumeration date
03/19/2007
Last updated
12/18/2013
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