Healthcare Provider Details

I. General information

NPI: 1215948971
Provider Name (Legal Business Name): MIDWEST FERTILITY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 EAST DUPONT ROAD SUITE 220
FORT WAYNE IN
46825
US

IV. Provider business mailing address

12188 A N MERIDIAN ST SUITE 250
CARMEL IN
46032
US

V. Phone/Fax

Practice location:
  • Phone: 260-490-3456
  • Fax: 260-490-4319
Mailing address:
  • Phone: 317-571-1637
  • Fax: 317-571-9483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN J KOLODZEJ
Title or Position: ADMINISTRATOR
Credential:
Phone: 317-571-1637