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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