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NPI Code Detail

MEDICARE: PROFESSIONAL EMERGENCY PHYSICIANS INC

MEDICARE: PROFESSIONAL EMERGENCY PHYSICIANS INC
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
1207P00000XEmergency Medicine Physician
2363AM0700XMedical Physician Assistant

Other Identifiers

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

General Provider Information

NPI Number : 1215044102
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL EMERGENCY PHYSICIANS INC
Provider Business Mailing Address
First Line : 2414 E STATE BLVD
Second Line : SUITE 202
City : FORT WAYNE
State : IN
Zip : 46805-4760
Country : US
Telephone Number : 260-482-4440
Fax Number :
Provider Business Practice Location Address
First Line : 401 N SAWYER RD
Second Line :
City : KENDALLVILLE
State : IN
Zip : 46755-2568
Country : US
Telephone Number : 260-347-1100
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. THOMAS E GUTWEIN
Credential : MD
Telephone Number : 260-482-4440
Provider Enumeration Date : 08/24/2006
Last Update Date : 09/11/2025

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