MEDICARE: MICHAEL J PHEND, MD

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	207R00000X	Internal Medicine Physician	01030254	IN

General Provider Information

NPI Number	:	1346380847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL J PHEND, MD

Provider Business Mailing Address
First Line	:	6728 SWEET WOOD CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-8127
Country	:	US
Telephone Number	:	260-482-1681
Fax Number	:	260-482-1857

Provider Business Practice Location Address
First Line	:	3124 E STATE BLVD
Second Line	:	SUITE 3F
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4798
Country	:	US
Telephone Number	:	260-482-1681
Fax Number	:	260-482-1857

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MICHEAL JAMES PHEND
Credential	:	MD
Telephone Number	:	260-482-1681

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	01/17/2008

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