Healthcare Provider Details

I. General information

NPI: 1932038544
Provider Name (Legal Business Name): AESTHETIC MEDICINE CONSULTING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 E DUPONT RD STE 236
FORT WAYNE IN
46825-1603
US

IV. Provider business mailing address

2510 E DUPONT RD STE 236
FORT WAYNE IN
46825-1603
US

V. Phone/Fax

Practice location:
  • Phone: 260-490-7111
  • Fax: 260-490-2286
Mailing address:
  • Phone: 260-490-7111
  • Fax: 260-490-2286

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: DR. SAMUEL LOUIS COREY II
Title or Position: PRESIDENT
Credential: MD
Phone: 260-490-7111