Healthcare Provider Details

I. General information

NPI: 1316997281
Provider Name (Legal Business Name): JOHN JACOB SAALWAECHTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W CAMP ST
LEBANON IN
46052-1647
US

IV. Provider business mailing address

504 W CAMP ST
LEBANON IN
46052-1647
US

V. Phone/Fax

Practice location:
  • Phone: 765-482-7005
  • Fax: 765-483-3023
Mailing address:
  • Phone: 765-482-7005
  • Fax: 765-483-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301062669
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01022859A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: