Organization
GREAT LAKES PEDIATRIC SURGEONS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID A. SMITH M.D. (PRESIDENT)
(260) 469-7337
Entity
Organization
Contact information
Practice address
7613 W JEFFERSON BLVD STE 200, FORT WAYNE, IN 46804-4182
(260) 469-7337
(260) 469-7340
Mailing address
7613 W JEFFERSON BLVD STE 200, FORT WAYNE, IN 46804-4182
(260) 469-7337
(260) 469-7340
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
—
—
Other
Enumeration date
11/29/2005
Last updated
03/14/2008
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