MEDICARE: ANNA MENZE-WAGNER 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	207Q00000X	Family Medicine Physician	11018731A	IN
2	207Q00000X	Family Medicine Physician	02005149A	IN

General Provider Information

NPI Number	:	1831547124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MENZE-WAGNER DO

Provider Business Mailing Address
First Line	:	6920 POINTE INVERNESS WAY STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7934
Country	:	US
Telephone Number	:	260-458-3760
Fax Number	:	260-458-3761

Provider Business Practice Location Address
First Line	:	2512 E DUPONT RD STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1609
Country	:	US
Telephone Number	:	260-458-3760
Fax Number	:	260-458-3761

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

Provider Enumeration Date	:	05/27/2016
Last Update Date	:	04/21/2026

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