Organization
FORT WAYNE DERMATOLOGY CONSULTANTS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE WAGGONER (CEO)
(260) 469-1444
Entity
Organization
Contact information
Practice address
7881 CARNEGIE BLVD, FORT WAYNE, IN 46804-5792
(260) 436-8000
(260) 434-0929
Mailing address
7881 CARNEGIE BLVD, FORT WAYNE, IN 46804-5792
(260) 436-8000
(260) 434-0929
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D0974991
CLIA
IN
Enumeration date
01/15/2025
Last updated
01/15/2025
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