Individual
STEVEN J. MOOIBROEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11123 PARKVIEW PLAZA DR STE 106, FORT WAYNE, IN 46845-1707
(260) 672-6550
(260) 672-6565
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01054479A
IN
208000000X
Pediatrics Physician
01054479A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000196870
ANTHEM
IN
01
—
00002092742 02
UNITED
—
01
—
12184
PHYSICIANS HEALTH PLAN
IN
05
—
200330780
—
IN
01
—
3937240024
MEDICARE DMEPOS
IN
01
—
7559229
AETNA
—
Enumeration date
12/27/2005
Last updated
12/15/2022
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