Individual
GREGORY M SASSMANNSHAUSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 436-8585
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
(260) 436-8585
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01057188A
IN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
01057188A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000279430
ANTHEM
—
01
—
200046124
RAILROAD MEDICARE
—
05
—
200421590A
—
IN
Enumeration date
05/24/2005
Last updated
11/07/2016
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