CREDO HEALTH GROUP LLC NPI 1407203672

NPI Information

  • NPI: 1407203672
  • Provider Name: CREDO HEALTH GROUP, LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • :
  • CLIA Number: 15D2130494
  • Address: 10050 AUBURN PARK DR
    FORT WAYNE, IN
    ZIP 46825
  • Phone: (260) 432-6459

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NPI Details

CREDO HEALTH GROUP, LLC is a family medicine in Fort Wayne, IN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CREDO HEALTH GROUP, LLC NPI is 1407203672. The provider is registered as an organization entity type and is a single specialty group.
The provider .

The provider's business location address is:

10050 AUBURN PARK DR
FORT WAYNE, IN
ZIP 46825-389
Phone: (260) 432-6459
Fax: (260) 240-5284

The provider's authorized official is Andrew J. Mullally .
The authorized official title is Owner and has the following contact phone number (260) 445-5829.

The CLIA number assigned to this NPI record is 15D2130494 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/18/2016 and was last updated on 2/14/2025.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine01074259AINDIANAYes

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: 11/21/2025

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