Organization
FORT WAYNE MEDICAL ONCOLOGY AND HEMATOLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETHANY GISSLEN (CFO)
(260) 484-8830
Entity
Organization
Contact information
Practice address
2514 E DUPONT RD STE 100, FORT WAYNE, IN 46825-1619
(260) 484-8830
(260) 483-1911
Mailing address
6610 MUTUAL DR, FORT WAYNE, IN 46825-4236
(260) 484-8830
(260) 483-1911
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100053330A
—
IN
01
—
CA4536
MEDICARE RR
IN
Enumeration date
10/24/2005
Last updated
12/04/2023
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