Organization
NORTHEAST INDIANA GENETICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH BADER (OFFICE MANAGER)
(260) 482-3886
Entity
Organization
Contact information
Practice address
7230 ENGLE RD, FORT WAYNE, IN 46804-2209
(260) 482-3886
(260) 482-1910
Mailing address
7230 ENGLE RD, FORT WAYNE, IN 46804-2209
(260) 482-3886
(260) 482-1910
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01022953A
PHYSICIAN MEDICAL LICENSING
IN
Enumeration date
01/27/2014
Last updated
01/31/2018
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