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1760481766

NPI Code Detail

MEDICARE: JEFFREY P LETZER DO

MEDICARE: JEFFREY P LETZER 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
1	207RH0003X	Hematology & Oncology Physician	5101010182	MI
2	207RH0003X	Hematology & Oncology Physician	02005703A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0N89040	OTHER	MI	MEDICARE PLUS BLUE MICHIGAN
6	830007320	OTHER	MI	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01008954	OTHER	MI	HEALTHPLUS OF MICHIGAN
3	14662	OTHER	MI	HEALTH PLAN OF MICHIGAN HMO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	F59303	OTHER	MI	TRICARE
7	3600159	OTHER	MI	PHP MID MICHIGAN
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	JL010182	OTHER	MI	BLUE CROSS BLUE SHIELD MICHIGAN
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760481766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY P LETZER 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	:	11050 PARKVIEW CIRCLE DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1739
Country	:	US
Telephone Number	:	833-744-8326
Fax Number	:	260-425-6845

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	03/27/2025

Similar Medicare Providers

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Practice Location Address:

11050 PARKVIEW CIRCLE DR
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46845-1739

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1366443129 — ALAN M YAHANDA MD
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1467420760 — DR. MURUGAVEL M MUTHUSAMY M.D.
Practice Location Address:

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Practice Fax: 260-425-6845

1821034307 — DR. SYED A ATHER M.D.
Practice Location Address:

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Practice Fax: 260-266-7585

1053335349 — DR. PATRICIA L CLARK MD
Practice Location Address:

11050 PARKVIEW CIRCLE DR
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1902994999 — MRS. MEREDITH LEIGH LETZER PA-C
Practice Location Address:

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Practice Fax: 260-425-6845

Directions to “ JEFFREY P LETZER DO” Practice Location

Language	Start Address	Practice Location

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