Organization
ELKHART PODIATRY CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL A COOPER DPM (PRESIDENT)
(574) 264-7180
Entity
Organization
Contact information
Practice address
1723 E BRISTOL ST, ELKHART, IN 46514-3968
(574) 264-7180
(574) 264-1875
Mailing address
1723 E BRISTOL ST, ELKHART, IN 46514-3968
(574) 264-7180
(574) 264-1875
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB8089
RAILROAD MEDICARE
—
Enumeration date
04/12/2007
Last updated
10/16/2008
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