MEDICARE: DR. SHERWIN Y. KEPES PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist		IN

General Provider Information

NPI Number	:	1144415886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERWIN Y. KEPES PH.D.

Provider Business Mailing Address
First Line	:	6026 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7639
Country	:	US
Telephone Number	:	260-749-8419
Fax Number	:	260-749-0335

Provider Business Practice Location Address
First Line	:	6026 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7639
Country	:	US
Telephone Number	:	260-749-8419
Fax Number	:	260-749-0335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/28/2007

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