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NPI Code Detail

MEDICARE: ASSOCIATED SURGEONS AND PHYSICIANS, LLC

MEDICARE: ASSOCIATED SURGEONS AND PHYSICIANS, 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
1213ES0103XFoot & Ankle Surgery Podiatrist

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 : 1629529029
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASSOCIATED SURGEONS AND PHYSICIANS, LLC
Provider Business Mailing Address
First Line : 2518 E DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1675
Country : US
Telephone Number : 260-432-4400
Fax Number : 260-969-6833
Provider Business Practice Location Address
First Line : 7920 W. JEFFERSON BLVD.
Second Line : STE. 230
City : FORT WAYNE
State : IN
Zip : 46804-4166
Country : US
Telephone Number : 260-432-7600
Fax Number : 260-436-8498
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : LILA BRAGER
Credential :
Telephone Number : 260-432-4400
Provider Enumeration Date : 10/20/2016
Last Update Date : 10/20/2016

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