MEDICARE: ASSOCIATED SURGEONS AND PHYSICIANS, LLC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1841444114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED SURGEONS AND PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	2518 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1675
Country	:	US
Telephone Number	:	260-432-4400
Fax Number	:	260-969-6884

Provider Business Practice Location Address
First Line	:	11141 PARKVIEW PLAZA DR
Second Line	:	SUITE 305
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1713
Country	:	US
Telephone Number	:	260-484-9611
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	MRS. LILA BRAGER
Credential	:
Telephone Number	:	260-432-4400

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	07/21/2022

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