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NPI Code Detail

MEDICARE: MATTHEW J SPRUNGER MD

MEDICARE: MATTHEW J SPRUNGER MD
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
1207V00000XObstetrics & Gynecology Physician01031939AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1160050659OTHERINRAIL ROAD MEDICARE

General Provider Information

NPI Number : 1801886460
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW J SPRUNGER MD
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 : 260-969-6898
Provider Business Practice Location 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 : 260-969-6898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 08/26/2016

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