Organization
FORT WAYNE UROLOGY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN HIMMELEIN (OFFICE MANAGER)
(260) 482-8681
Entity
Organization
Contact information
Practice address
1818 CAREW ST, SUITE 210, FORT WAYNE, IN 46805-4788
(260) 482-8681
(260) 373-4699
Mailing address
1818 CAREW ST, SUITE 210, FORT WAYNE, IN 46805-4788
(260) 482-8681
(260) 373-4699
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100050350
—
IN
Enumeration date
11/06/2006
Last updated
05/27/2008
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