Organization
FORT WAYNE CARDIOLOGY CORPORATION
Active
Parent organization
FORT WAYNE CARDIOLOGY CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
FORT WAYNE CARDIOLOGY CORPORATION
Authorized official
DR. RAYMOND DUSMAN M.D. (CEO)
(260) 481-4700
Entity
Organization
Contact information
Practice address
11558 SR 111, PAULDING, OH 45879
(260) 481-4700
(260) 481-4808
Mailing address
PO BOX 11829, FORT WAYNE, IN 46861-1829
(260) 481-4700
(260) 481-4808
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200425420M
—
IN
01
—
CK8615
RR MEDICARE
OH
Enumeration date
12/20/2005
Last updated
10/07/2008
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