Patrick    Deheer    DPM
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000006127
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
1209 East State Road 44
Shelbyville, IN 46176
United States
County
Shelby
Phone
3174210941 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address