MEDICARE: APPLESEED PEDIATRICS, PC

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	208000000X	Pediatrics Physician	01022184	IN

General Provider Information

NPI Number	:	1619057130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLESEED PEDIATRICS, PC

Provider Business Mailing Address
First Line	:	6108 MAPLECREST RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-2524
Country	:	US
Telephone Number	:	260-486-3300
Fax Number	:	260-486-3600

Provider Business Practice Location Address
First Line	:	6108 MAPLECREST RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-2524
Country	:	US
Telephone Number	:	260-486-3300
Fax Number	:	260-486-3600

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. RONALD R HALL
Credential	:	M.D.
Telephone Number	:	260-486-3300

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/22/2020

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