Healthcare Provider Details

I. General information

NPI: 1255415352
Provider Name (Legal Business Name): AYDIN T. KIZILISIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 W JEFFERSON BLVD SUITE 200
FORT WAYNE IN
46804-4159
US

IV. Provider business mailing address

6920 POINTE INVERNESS WAY STE 200 MEDPARTNERS, ATTN: BARB COPELAND
FORT WAYNE IN
46804-7934
US

V. Phone/Fax

Practice location:
  • Phone: 260-435-6275
  • Fax: 260-435-6279
Mailing address:
  • Phone: 260-479-3514
  • Fax: 260-479-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number01062836A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01062836A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: