Individual
MATTHEW RYAN BIENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5886
(260) 484-8551
(260) 482-5060
Mailing address
5052 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 484-8551
(260) 482-5060
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001463A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300006065
—
IN
Enumeration date
09/07/2012
Last updated
10/23/2018
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