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1568464972

NPI Code Detail

MEDICARE: RAYMOND E DUSMAN JR. MD

MEDICARE: RAYMOND E DUSMAN JR. 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	207RC0000X	Cardiovascular Disease Physician	01033566A	IN
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	01033566A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00785633	OTHER	IN	R.R. MEDICARE
3	060070557	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000641075	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1568464972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND E DUSMAN JR. MD

Provider Business Mailing Address
First Line	:	1234 E. DUPONT RD.
Second Line	:	3
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1545
Country	:	US
Telephone Number	:	260-373-9700
Fax Number	:	260-373-9740

Provider Business Practice Location Address
First Line	:	1819 CAREW ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4705
Country	:	US
Telephone Number	:	260-481-4700
Fax Number	:	260-481-4808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	03/20/2013

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Directions to “ RAYMOND E DUSMAN JR. MD” 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.

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