MEDICARE: PROFESSIONAL EMERGENCY PHYSICIANS INC

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	207P00000X	Emergency Medicine Physician
2	363AM0700X	Medical Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184731069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL EMERGENCY PHYSICIANS INC

Provider Business Mailing Address
First Line	:	2414 E STATE BLVD
Second Line	:	SUITE 202
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4760
Country	:	US
Telephone Number	:	260-482-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	353 N OAK ST
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-1623
Country	:	US
Telephone Number	:	260-248-9000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS E GUTWEIN
Credential	:	MD
Telephone Number	:	260-482-4440

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	09/11/2025

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