Individual
GERALD DEAN MCCALEB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2525 LAKE AVE, FORT WAYNE, IN 46805-5407
(260) 484-4153
(260) 484-2337
Mailing address
2525 LAKE AVE, FORT WAYNE, IN 46805-5407
(260) 484-4153
(260) 484-2337
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275614109
—
IN
Enumeration date
08/06/2018
Last updated
08/06/2018
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