Provider Demographics
NPI:1366762718
Name:ADVANCED ORTHOPAEDIC FOOT AND ANKLE CLINIC OF INDIANA INC
Entity type:Organization
Organization Name:ADVANCED ORTHOPAEDIC FOOT AND ANKLE CLINIC OF INDIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SIDERYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-253-3006
Mailing Address - Street 1:1438 AGGIE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-4098
Mailing Address - Country:US
Mailing Address - Phone:317-253-3006
Mailing Address - Fax:317-253-3006
Practice Address - Street 1:1438 AGGIE LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-4098
Practice Address - Country:US
Practice Address - Phone:317-253-3006
Practice Address - Fax:317-253-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034522207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty