Individual
MARK C. DICKMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1818 CAREW ST STE 120, FORT WAYNE, IN 46805-4764
(260) 425-6200
(260) 425-6205
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01063502A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000777143
ANTHEM
IN
05
—
200857350
—
IN
05
—
30530200
—
WI
01
—
763
DEAN HEALTH INSURANCE
WI
Enumeration date
10/06/2005
Last updated
10/15/2022
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