Organization
INDIANA EPILEPSY AND CHILD NEUROLOGY, INC.
Active
Organization
INDIANA EPILEPSY AND CHILD NEUROLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DON STAUFFER (VICE PRESIDENT)
(260) 426-9996
Entity
Organization
Contact information
Practice address
4310 LAKE AVE, FORT WAYNE, IN 46815-7222
(260) 426-9996
(260) 426-9996
Mailing address
4310 LAKE AVE, FORT WAYNE, IN 46815-7222
(260) 426-9996
(260) 426-9996
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
—
—
Other
Enumeration date
11/21/2006
Last updated
08/22/2020
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