MEDICARE: CREDO HEALTH GROUP, 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	207Q00000X	Family Medicine Physician	01074259A	IN

General Provider Information

NPI Number	:	1407203672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREDO HEALTH GROUP, LLC

Provider Business Mailing Address
First Line	:	10050 AUBURN PARK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2389
Country	:	US
Telephone Number	:	260-432-6459
Fax Number	:	260-240-5284

Provider Business Practice Location Address
First Line	:	10050 AUBURN PARK DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2389
Country	:	US
Telephone Number	:	260-432-6459
Fax Number	:	260-240-5284

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREW J. MULLALLY
Credential	:	M.D.
Telephone Number	:	260-445-5829

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	02/14/2025

Similar Medicare Providers

1447955406 — PREMISE HEALTH OF INDIANA MEDICAL PC
Practice Location Address:

10006 AUBURN PARK DR
FORT WAYNE, IN
46825-2389

Practice Phone: 260-247-8020
Practice Fax:

1548203300 — MARK WILLIAM DELBELLO M.D.
Practice Location Address:

10002 AUBURN PARK DR
FORT WAYNE, IN
46825-2389

Practice Phone: 260-482-1681
Practice Fax: 260-482-1857

1992097026 — ASSOCIATED SURGEONS AND PHYSICIANS, LLC
Practice Location Address:

10002 AUBURN PARK DR
FORT WAYNE, IN
46825-2389

Practice Phone: 260-482-1681
Practice Fax: 260-482-1857

1477800829 — MR. GEOFFREY GEORGE GEPHART FNP-BC
Practice Location Address:

10012 AUBURN PARK DR
FORT WAYNE, IN
46825-2389

Practice Phone: 317-644-8457
Practice Fax:

1164860086 — DR. ANDREW J MULLALLY MD
Practice Location Address:

10050 AUBURN PARK DR
FORT WAYNE, IN
46825-2389

Practice Phone: 260-432-6459
Practice Fax: 260-240-5284

1699223289 — HEATHER MARIE RICHARDVILLE DPT
Practice Location Address:

10006 AUBURN PARK DR
FORT WAYNE, IN
46825-2389

Practice Phone: 260-497-7191
Practice Fax: 260-497-7791

Directions to “CREDO HEALTH GROUP, 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.