# INDIANA PLASTIC SURGERY CENTER, PC

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

## Provider details

- **NPI number:** 1174861454
- **Authorized official:** DR. ROBERT N SEVERINAC M.D. (PRESIDENT)
- **Authorized official phone:** (260) 489-0099

## Contact information

- **Practice address:** 10020 DUPONT CIRCLE CT, SUITE 100, FORT WAYNE, IN 46825-1620
- **Practice address phone:** (260) 489-0099
- **Practice address fax:** (260) 489-0066
- **Mailing address:** 10020 DUPONT CIRCLE CT, SUITE 100, FORT WAYNE, IN 46825-1620
- **Mailing address phone:** (260) 489-0099
- **Mailing address fax:** (260) 489-0066

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 01043388A | IN | Yes |

## Other

- **Enumeration date:** 01/22/2013
- **Last updated:** 01/22/2013