| Dr Todd Allen Dillon, MD | |
|
902 Provident Dr, Suite A, Warsaw, IN 46580-3378 | |
| (574) 269-8338 | |
| (574) 269-8339 |
| Full Name | Dr Todd Allen Dillon |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 902 Provident Dr, Warsaw, Indiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285653956 | NPI | - | NPPES |
| 200369220 | Medicaid | IN | |
| 2298115 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 01055103A (Indiana) | Primary |
| Entity Name | Kosciusko Medical Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1932349594 PECOS PAC ID: 5496809956 Enrollment ID: O20090818000398 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Todd Allen Dillon, MD 6920 Pointe Inverness Way Ste 200, Fort Wayne, IN 46804-7934 Ph: (260) 479-3513 | Dr Todd Allen Dillon, MD 902 Provident Dr, Suite A, Warsaw, IN 46580-3378 Ph: (574) 269-8338 |
Mamata Eagam, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 902 Provident Drive, Suite A, Warsaw, IN 46580 Phone: 574-269-8338 Fax: 574-269-8339 | |
Dr. Jeffrey Douglas O'dell, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1355 Mariners Dr, Warsaw, IN 46582 Phone: 574-267-6778 Fax: 574-267-3134 | |
Dr. Anita I Kishan, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2219 Dubois Dr, Warsaw, IN 46580 Phone: 574-269-3420 Fax: 574-269-2234 | |
Dr. Miry Lisbeth Lanphere, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1355 Mariners Dr, Warsaw, IN 46582 Phone: 574-267-6778 Fax: 574-267-3134 | |
Dr. Charles Lee Hill Iii, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 1355 Mariners Dr, Warsaw, IN 46582 Phone: 574-267-6778 Fax: 574-267-3134 |