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Individual

THEODORE STEPHEN SAUER JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
300 W OHIO ST, KENDALLVILLE, IN 46755-2018
(260) 212-1906
(260) 279-5737
Mailing address
2622 LAKE AVE, FORT WAYNE, IN 46805-5410
(260) 425-3100
(260) 745-1321

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01059997A
IN
207Q00000X
Family Medicine Physician
4301084790
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000375796
ANTHEM
IN
05
200529220
IN
Enumeration date
01/18/2006
Last updated
06/17/2024
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