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NPI Code Detail

MEDICARE: DR. CHAD RYAN PERCIFIELD DO

MEDICARE: DR. CHAD RYAN PERCIFIELD DO
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
12084P0800XPsychiatry Physician5101025883MI
22084P0800XPsychiatry Physician6704TN
32084P0800XPsychiatry Physician36447MS
42084P0800XPsychiatry Physician02006062AIN
52084P0804XChild & Adolescent Psychiatry Physician5101025883MI

General Provider Information

NPI Number : 1629569140
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAD RYAN PERCIFIELD DO
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 909 E STATE BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-3404
Country : US
Telephone Number : 260-481-2700
Fax Number : 260-481-2838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2018
Last Update Date : 03/05/2026

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