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NPI Code Detail

MEDICARE: DR. JEFFREY WALTER SASSMANNSHAUSEN M.D.

MEDICARE: DR. JEFFREY WALTER SASSMANNSHAUSEN M.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
1174400000XSpecialist

General Provider Information

NPI Number : 1316928195
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY WALTER SASSMANNSHAUSEN M.D.
Provider Business Mailing Address
First Line : 5650 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7140
Country : US
Telephone Number : 260-436-9696
Fax Number : 888-370-2203
Provider Business Practice Location Address
First Line : 5650 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7140
Country : US
Telephone Number : 260-436-9696
Fax Number : 888-370-2203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 09/23/2022

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