# INDIANA UNIVERSITY HEALTH FORT WAYNE PHYSICIANS, LLC

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

## Provider details

- **NPI number:** 1316550445
- **Authorized official:** JONATHAN W. VANATOR (CFO)
- **Authorized official phone:** (317) 963-3395

## Contact information

- **Practice address:** 2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
- **Practice address phone:** (765) 747-3111
- **Mailing address:** 250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
- **Mailing address phone:** (888) 484-3258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/28/2020
- **Last updated:** 11/13/2023