Individual
OLEG VENGEROWSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD21759
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000164625
UNISON HEALTH
SC
01
—
050081427
RR MEDICARE
SC
01
—
20023126
SELECT HEALTH
SC
05
—
217599
—
SC
Enumeration date
08/23/2007
Last updated
02/20/2019
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