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FORT WAYNE CARDIOVASCULAR SURGEON NPI 1790718765


NPI Information

NPI: 1790718765
Provider Name: FORT WAYNE CARDIOVASCULAR SURGEON
Classification: Thoracic Surgery (Cardiothoracic Vascular Surgery) - 208G00000X
Entity Type: Organization
Address:
11123 PARKVIEW PLAZA DR
SUITE 202
FORT WAYNE, IN
ZIP 46845
Phone: (260) 483-6448
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FORT WAYNE CARDIOVASCULAR SURGEON is a thoracic surgery cardiothoracic vascular surgery in Fort Wayne, IN. The provider is a thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. FORT WAYNE CARDIOVASCULAR SURGEON NPI is 1790718765. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

11123 PARKVIEW PLAZA DR
SUITE 202
FORT WAYNE, IN
ZIP 46845-707
Phone: (260) 483-6448
Fax: (260) 373-4167

The provider's authorized official is Douglas L Gray .
The authorized official title is President/partner and has the following contact phone number (260) 483-6448.

The enumeration date for this NPI number is 7/10/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)50000046AINDIANAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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