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NPI Code Detail

MEDICARE: BRUCE J. HOPEN M.D.

MEDICARE: BRUCE J. HOPEN 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
1207Q00000XFamily Medicine Physician01029474AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2080121944OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11412OTHERPHYSICIANS HEALTH PLAN
3000000091883OTHERBLUE CROSS BLUE SHIELD
4000000000826OTHERMPLAN
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871584284
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE J. HOPEN M.D.
Provider Business Mailing Address
First Line : 3534 BROOKLYN AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46809-1361
Country : US
Telephone Number : 260-747-6171
Fax Number : 260-478-5125
Provider Business Practice Location Address
First Line : 3534 BROOKLYN AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46809-1361
Country : US
Telephone Number : 260-478-5130
Fax Number : 260-478-5133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 02/22/2013

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