Healthcare Provider Details

I. General information

NPI: 1184731069
Provider Name (Legal Business Name): PROFESSIONAL EMERGENCY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 N OAK ST
COLUMBIA CITY IN
46725-1623
US

IV. Provider business mailing address

2414 E STATE BLVD SUITE 202
FORT WAYNE IN
46805-4760
US

V. Phone/Fax

Practice location:
  • Phone: 260-248-9000
  • Fax:
Mailing address:
  • Phone: 260-482-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. THOMAS E GUTWEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 260-482-4440