Healthcare Provider Details

I. General information

NPI: 1396788204
Provider Name (Legal Business Name): MICHAEL T ROUTSONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N TOWNLINE RD
LAGRANGE IN
46761-1325
US

IV. Provider business mailing address

608 UNION CHAPEL RD
FORT WAYNE IN
46845-9357
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-9111
  • Fax:
Mailing address:
  • Phone: 260-482-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01060091A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: