Organization
PODIATRIC MEDICAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN K GRANDFIELD DPM (PRESIDENT)
(219) 736-8915
Entity
Organization
Contact information
Practice address
303 W 89TH AVE, SUITE E-1, MERRILLVILLE, IN 46410
(219) 736-8915
(219) 736-8928
Mailing address
303 W 89TH AVE, SUITE E-1, MERRILLVILLE, IN 46410
(219) 736-8915
(219) 736-8928
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
07000353A
IN
213E00000X
Podiatrist
07000785A
IN
213E00000X
Podiatrist
Primary
07000922A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084756
ANTHEM
IN
01
—
000000084758
ANTHEM
IN
01
—
00000209276
ANTHEM
IN
05
—
100148090
—
IN
05
—
100207960
—
IN
01
—
1089370001
MEDICARE DMERC
—
05
—
200326020
—
IN
01
—
480016271
RR MEDICARE
—
01
—
480020342
RR MEDICARE
—
01
—
480032400
RR MEDICARE
—
Enumeration date
08/26/2006
Last updated
12/05/2013
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