Organization
CARDIOVASCULAR ASSOCIATES OF NORTHEASTERN INDIANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN CSICSKO MD (OWNER)
(260) 436-6098
Entity
Organization
Contact information
Practice address
7900 W JEFFERSON BLVD, SUITE 303, FT WAYNE, IN 46804-4128
(260) 436-6098
(260) 436-3173
Mailing address
7900 W JEFFERSON BLVD, SUITE 303, FT WAYNE, IN 46804-4128
(260) 436-6098
(260) 436-3173
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200049160A
—
IN
01
—
CA5617
TAVELERS MEDICARE
IN
Enumeration date
01/24/2006
Last updated
11/28/2011
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