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Contact Information

FORT WAYNE INTEGRATIVE MEDICINE
3919 W JEFFERSON BLVD
FORT WAYNE, IN46804-6811
 Phone: 260-475-0772
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for FORT WAYNE INTEGRATIVE MEDICINE

NPI # 1245686989
LBN Legal business name FORT WAYNE INTEGRATIVE MEDICINE
Authorized official VISHAAL VEERULA - (MEDICAL DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 05/12/2016
Last updated 04/18/2018 - About 8 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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