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Organization
ORTHOPAEDICS NORTHEAST, PC
Active
Organization
ORTHOPAEDICS NORTHEAST, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND KUSISTO (CEO)
(260) 484-8551
Entity
Organization
Contact information
Practice address
605 N WALNUT ST, NORTH MANCHESTER, IN 46962-1857
(260) 484-8551
(260) 484-9603
Mailing address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 484-8551
(260) 484-9603
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
50001907A
IN
207X00000X
Orthopaedic Surgery Physician
50001907A
IN
208100000X
Physical Medicine & Rehabilitation Physician
50001907A
IN
213E00000X
Podiatrist
Primary
50001907A
IN
Other
Enumeration date
03/27/2006
Last updated
09/11/2025
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