MEDICARE: CARDIOVASCULAR ASSOCIATES OF NORTHEASTERN INDIANA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CA5617	OTHER	IN	TAVELERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083684948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR ASSOCIATES OF NORTHEASTERN INDIANA LLC

Provider Business Mailing Address
First Line	:	7900 W JEFFERSON BLVD
Second Line	:	SUITE 303
City	:	FT WAYNE
State	:	IN
Zip	:	46804-4128
Country	:	US
Telephone Number	:	260-436-6098
Fax Number	:	260-436-3173

Provider Business Practice Location Address
First Line	:	7900 W JEFFERSON BLVD
Second Line	:	SUITE 303
City	:	FT WAYNE
State	:	IN
Zip	:	46804-4128
Country	:	US
Telephone Number	:	260-436-6098
Fax Number	:	260-436-3173

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN CSICSKO
Credential	:	MD
Telephone Number	:	260-436-6098

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	11/28/2011

Similar Medicare Providers

1003813692 — CARDIOSOM OF FT. WAYNE, INC
Practice Location Address:

1625 MAGNAVOX WAY
FT WAYNE, IN
46804-1535

Practice Phone: 888-857-5337
Practice Fax: 260-459-9247

1073510178 — CARDIOSOM LLC DBA MD SLEEP OF FT. WAYNE
Practice Location Address:

1625 MAGNAVOX WAY
FT WAYNE, IN
46804-1535

Practice Phone: 260-459-9248
Practice Fax: 260-459-9247

1750358347 — DALE FREDERICK FATH OD
Practice Location Address:

7750 W JEFFERSON BLVD
FT WAYNE, IN
46804

Practice Phone: 260-459-9595
Practice Fax: 260-459-9494

1578528790 — HOME CARE SERVICES, INC
Practice Location Address:

6202 CONSTITUTION DR , SUITE C
FT WAYNE, IN
46804-1583

Practice Phone: 260-459-2917
Practice Fax: 260-459-2894

1871537753 — MRS. SUSAN MARIE TIELKER-SHARPE LCSW LMFT ACSW
Practice Location Address:

4656 W JEFFERSON BLVD , SUITE 285
FT WAYNE, IN
46804

Practice Phone: 260-422-9372
Practice Fax: 260-422-0843

1164524781 — MR. THOMAS J DOUST LCSW
Practice Location Address:

3154 MALLARD COVE LANE
FT WAYNE, IN
46804

Practice Phone: 260-432-2489
Practice Fax: 260-432-8236

Directions to “CARDIOVASCULAR ASSOCIATES OF NORTHEASTERN INDIANA LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.