MEDICARE: TODD ROBERT PAGE MD

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	207Q00000X	Family Medicine Physician	01047310	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5988752	OTHER	IN	AETNA
2	15D0962889	OTHER	IN	CLIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	01047310	OTHER	IN	STATE LICENSE

General Provider Information

NPI Number	:	1184622367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD ROBERT PAGE MD

Provider Business Mailing Address
First Line	:	5501 US HIGHWAY 30 W
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-8998
Country	:	US
Telephone Number	:	260-270-6181
Fax Number	:	260-469-1022

Provider Business Practice Location Address
First Line	:	5501 US HIGHWAY 30 W
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-8998
Country	:	US
Telephone Number	:	260-270-6181
Fax Number	:	260-469-1022

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	06/12/2024

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Directions to “ TODD ROBERT PAGE MD” Practice Location

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