Organization
NORTHEAST MEDICAL ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAREN SUE EVANS M.D. (PHYSICIAN)
(260) 480-2600
Entity
Organization
Contact information
Practice address
1234 E. DUPONT RD., SUITE 6, FORT WAYNE, IN 46825-1545
(260) 480-2600
(260) 496-8077
Mailing address
1234 E. DUPONT RD., SUITE 6, FORT WAYNE, IN 46825-1545
(260) 480-2600
(260) 496-8077
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50004246A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003807850
GROUP NPI
IN
05
—
200335790A
—
IN
01
—
7795314
AETNA PIN
IN
01
—
CJ8803
MEDICARE RR
IN
Enumeration date
11/01/2005
Last updated
03/09/2011
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