Individual
CLEM JOHN WEGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 BROADWAY STE 350, FORT WAYNE, IN 46802-1412
(260) 423-2675
(260) 423-6621
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01082724A
IN
207Q00000X
Family Medicine Physician
11020177A
IN
208D00000X
General Practice Physician
01082724A
IN
208M00000X
Hospitalist Physician
01082724A
IN
Other
Enumeration date
06/20/2018
Last updated
05/17/2022
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