Graduated: 2025
NPI: 1164211298
Practice Locations (4)
11109 PARKVIEW PLAZA DR, SUITE 117
FORT WAYNE, IN 468451701
12844 COLDWATER RD, SUITE B
FORT WAYNE, IN 468458833
12844 COLDWATER RD, SUITE B
FORT WAYNE, IN 468459516
9823 AUBURN RD
FORT WAYNE, IN 468252347
Source: CMS National Downloadable File, September 2026.