| Credo Family Medicine | |
|
10228 Dupont Circle Dr E # 100b Fort Wayne IN 46825-1611 | |
| (260) 432-6459 | |
| Not Available |
| Full Name | Credo Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 10228 Dupont Circle Dr E # 100b, Fort Wayne, Indiana |
| Authorized Official Name and Position | Andrew J. Mullally (OWNER) |
| Authorized Official Contact | 2604455829 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Credo Family Medicine 10228 Dupont Circle Dr E # 100b Fort Wayne IN 46825-1611 Ph: (260) 432-6459 | Credo Family Medicine 10228 Dupont Circle Dr E # 100b Fort Wayne IN 46825-1611 Ph: (260) 432-6459 |
| NPI Number | 1407203672 |
|---|---|
| Provider Enumeration Date | 05/18/2016 |
| Last Update Date | 05/18/2016 |
| Medicare PECOS PAC ID | 2769775782 |
|---|---|
| Medicare Enrollment ID | O20160727002360 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407203672 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01074259A (Indiana) | Primary |
| Provider Name | David J Moran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679688295 PECOS PAC ID: 2163420910 Enrollment ID: I20090108000122 |
| Provider Name | Andrew J Mullally |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164860086 PECOS PAC ID: 6507080975 Enrollment ID: I20140918000377 |
| Provider Name | Cassandralee Herber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497284657 PECOS PAC ID: 3870864143 Enrollment ID: I20170804000189 |
| Provider Name | Emily Krach |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235622580 PECOS PAC ID: 3173879939 Enrollment ID: I20210712002116 |
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