Healthcare Provider Details

I. General information

NPI: 1629529029
Provider Name (Legal Business Name): ASSOCIATED SURGEONS AND PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 W. JEFFERSON BLVD. STE. 230
FORT WAYNE IN
46804-4166
US

IV. Provider business mailing address

2518 E DUPONT RD
FORT WAYNE IN
46825-1675
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-7600
  • Fax: 260-436-8498
Mailing address:
  • Phone: 260-432-4400
  • Fax: 260-969-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: LILA BRAGER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 260-432-4400