MEDICARE: DEAN DONALD DAUSCHER 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	01020094	IN

General Provider Information

NPI Number	:	1679568406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN DONALD DAUSCHER MD

Provider Business Mailing Address
First Line	:	5717 S ANTHONY BLVD
Second Line	:	SUITE 100
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-3386
Country	:	US
Telephone Number	:	260-441-3326
Fax Number	:	260-441-3214

Provider Business Practice Location Address
First Line	:	5717 S ANTHONY BLVD
Second Line	:	SUITE 100
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-3386
Country	:	US
Telephone Number	:	260-441-3326
Fax Number	:	260-441-3214

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/08/2007

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