# NORTHEAST INDIANA GENETICS, LLC

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

## Provider details

- **NPI number:** 1356764419
- **Authorized official:** MR. JOSEPH BADER (OFFICE MANAGER)
- **Authorized official phone:** (260) 482-3886

## Contact information

- **Practice address:** 7230 ENGLE RD, FORT WAYNE, IN 46804-2209
- **Practice address phone:** (260) 482-3886
- **Practice address fax:** (260) 482-1910
- **Mailing address:** 7230 ENGLE RD, FORT WAYNE, IN 46804-2209
- **Mailing address phone:** (260) 482-3886
- **Mailing address fax:** (260) 482-1910

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | NULL | Yes |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/27/2014
- **Last updated:** 01/31/2018