Individual
MACE ODLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3030 SANTA ROSA DR, FORT WAYNE, IN 46805-2827
(260) 515-3476
Mailing address
3030 SANTA ROSA DR, FORT WAYNE, IN 46805-2827
(260) 515-3476
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/11/2024
Last updated
07/11/2024
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