Healthcare Provider Details

I. General information

NPI: 1649604059
Provider Name (Legal Business Name): ANDREW WILLIAM RIEBE DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 BLUFFTON RD
FORT WAYNE IN
46809-2254
US

IV. Provider business mailing address

6221 BLUFFTON RD
FORT WAYNE IN
46809-2254
US

V. Phone/Fax

Practice location:
  • Phone: 260-747-4196
  • Fax: 260-747-4198
Mailing address:
  • Phone: 260-747-4196
  • Fax: 260-747-4198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number24007206A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: