# CARDIOVASCULAR ASSOCIATES OF NORTHEASTERN INDIANA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083684948
- **Authorized official:** JOHN CSICSKO MD (OWNER)
- **Authorized official phone:** (260) 436-6098

## Contact information

- **Practice address:** 7900 W JEFFERSON BLVD, SUITE 303, FT WAYNE, IN 46804-4128
- **Practice address phone:** (260) 436-6098
- **Practice address fax:** (260) 436-3173
- **Mailing address:** 7900 W JEFFERSON BLVD, SUITE 303, FT WAYNE, IN 46804-4128
- **Mailing address phone:** (260) 436-6098
- **Mailing address fax:** (260) 436-3173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/24/2006
- **Last updated:** 11/28/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200049160A | — | IN |
| 01 | — | CA5617 | TAVELERS MEDICARE | IN |