Healthcare Provider Details

I. General information

NPI: 1427809870
Provider Name (Legal Business Name): FUZE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 WICKER AVE
SAINT JOHN IN
46373-9400
US

IV. Provider business mailing address

9430 WICKER AVE
SAINT JOHN IN
46373-9400
US

V. Phone/Fax

Practice location:
  • Phone: 219-558-8068
  • Fax: 877-822-9116
Mailing address:
  • Phone: 219-558-8068
  • Fax: 877-822-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: ARIEL P BRAZZALE
Title or Position: CO-OWNER
Credential: NP
Phone: 219-669-1034