Organization
NORTHEAST INDIANA GENETIC COUNSELING CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA I BADER M.D. (PHYSICIAN)
(260) 482-3886
Entity
Organization
Contact information
Practice address
11143 PARKVIEW PLAZA DR, STE. 311, FORT WAYNE, IN 46845-1701
(260) 482-3886
(260) 482-1910
Mailing address
11143 PARKVIEW PLAZA DR, STE. 311, FORT WAYNE, IN 46845-1701
(260) 482-3886
(260) 482-1910
Taxonomy
Speciality
Code
Description
License number
State
207SC0300X
Clinical Cytogenetics Physician
01022953
IN
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
01022953
IN
208000000X
Pediatrics Physician
01022953
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100080650A
—
IN
05
—
100360290A
—
IN
Enumeration date
12/02/2005
Last updated
05/27/2009
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