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Organization
FORT WAYNE MEDICAL ONCOLOGY AND HEMATOLOGY, INC
Active
Organization
FORT WAYNE MEDICAL ONCOLOGY AND HEMATOLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETHANY GISSLEN (CFO)
(260) 484-8830
Entity
Organization
Contact information
Practice address
2514 E DUPONT RD STE 100, FORT WAYNE, IN 46825-1619
(260) 484-8830
(260) 483-1911
Mailing address
6610 MUTUAL DR, FORT WAYNE, IN 46825-4236
(260) 484-8830
(260) 483-1911
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100053330A
—
IN
01
—
CA4536
MEDICARE RR
IN
Enumeration date
10/24/2005
Last updated
12/04/2023
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