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NPI Code Detail

MEDICARE: FORT WAYNE MEDICAL ONCOLOGY AND HEMATOLOGY INC

MEDICARE: FORT WAYNE MEDICAL ONCOLOGY AND HEMATOLOGY INC
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
1332B00000XDurable Medical Equipment & Medical Supplies60005894IN

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 : 1639239171
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORT WAYNE MEDICAL ONCOLOGY AND HEMATOLOGY INC
Provider Business Mailing Address
First Line : 2514 E DUPONT ROAD SUITE 100
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1619
Country : US
Telephone Number : 260-484-8830
Fax Number : 260-483-1911
Provider Business Practice Location Address
First Line : 2514 E DUPONT ROAD SUITE 100
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1619
Country : US
Telephone Number : 260-484-8830
Fax Number : 260-483-1911
Authorized Official
Title or Position : MD - OWNER
Name : GARY GIZE
Credential : MD
Telephone Number : 260-484-8830
Provider Enumeration Date : 12/12/2006
Last Update Date : 08/01/2019

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Directions to “FORT WAYNE MEDICAL ONCOLOGY AND HEMATOLOGY INC ” Practice Location

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