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Individual

JOHN BENJAMIN BACCUS III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
500 ARCADE AVE STE 200, ELKHART, IN 46514-2485
(574) 294-8404
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-1069
(574) 237-6069

Taxonomy

Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
01072136A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201141150
IN
Enumeration date
02/17/2006
Last updated
05/10/2026
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