Individual
TODD ROBERT PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5501 US HIGHWAY 30 W, FORT WAYNE, IN 46818-8998
(260) 270-6181
(260) 469-1022
Mailing address
5501 US HIGHWAY 30 W, FORT WAYNE, IN 46818-8998
(260) 270-6181
(260) 469-1022
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01047310
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01047310
STATE LICENSE
IN
01
—
15D0962889
CLIA
IN
05
—
200218780A
—
IN
01
—
5988752
AETNA
IN
Enumeration date
07/12/2005
Last updated
06/12/2024
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