Healthcare Provider Details

I. General information

NPI: 1598482945
Provider Name (Legal Business Name): PFLUEGER PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 FOREST AVE
FORT WAYNE IN
46805-4620
US

IV. Provider business mailing address

1924 FOREST AVE
FORT WAYNE IN
46805-4620
US

V. Phone/Fax

Practice location:
  • Phone: 260-433-4991
  • Fax:
Mailing address:
  • Phone: 260-433-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: REID R PFLUEGER
Title or Position: OWNER
Credential: DO
Phone: 260-433-4991