| Fort Wayne Endocrinology Pc | |
|
5010 W Jefferson Blvd Fort Wayne IN 46804-6804 | |
| (260) 436-1248 | |
| (260) 436-7968 |
| Full Name | Fort Wayne Endocrinology Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5010 W Jefferson Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Jenney Newby (OFFICE MANAGER) |
| Authorized Official Contact | 2604361248 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Wayne Endocrinology Pc 5010 W Jefferson Blvd Fort Wayne IN 46804-6804 Ph: (260) 436-1248 | Fort Wayne Endocrinology Pc 5010 W Jefferson Blvd Fort Wayne IN 46804-6804 Ph: (260) 436-1248 |
| NPI Number | 1285786111 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 07/02/2010 |
| Medicare PECOS PAC ID | 9234104720 |
|---|---|
| Medicare Enrollment ID | O20040828000033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285786111 | NPI | - | NPPES |
| 200218650 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Ashok Kadambi |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1902863038 PECOS PAC ID: 8224003710 Enrollment ID: I20111216000118 |
| Provider Name | Donna M Lorntz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144589409 PECOS PAC ID: 7315194297 Enrollment ID: I20120828000772 |
| Provider Name | Desiree Heim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558769687 PECOS PAC ID: 8022333905 Enrollment ID: I20150217002267 |
| Provider Name | Ryan G Hartig |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1053747741 PECOS PAC ID: 1456647924 Enrollment ID: I20160908002839 |
| Provider Name | Crystal M Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861935918 PECOS PAC ID: 4789964909 Enrollment ID: I20161206000500 |
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