Patrick    Deheer    DPM
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000006124
Tax ID
352205377
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
11725 Illinois Street
Carmel, IN 46032
United States
County
Hamilton
Phone
3175801586 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address