Organization
EMERGENCY MEDICINE OF INDIANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TROY CLOUSE M.D. (PRESIDENT)
(260) 203-9600
Entity
Organization
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 203-9600
(260) 435-7933
Mailing address
10343 DAWSONS CREEK BLVD, SUITE A, FORT WAYNE, IN 46825-1906
(260) 203-9600
(260) 739-6167
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100082180A
—
IN
Enumeration date
03/15/2012
Last updated
03/08/2016
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