Healthcare Provider Details

I. General information

NPI: 1306812656
Provider Name (Legal Business Name): STEVEN C. BEHRENDSEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11143 PARKVIEW PLAZA DR STE 200
FORT WAYNE IN
46845-1728
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-8820
  • Fax: 260-266-8829
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number5101020838
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number02001828A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: