Medical school: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated: 1975
NPI: 1992749485
Practice Locations (1)
FORT WAYNE MEDICAL EDUCATION PROGRAM
750 BROADWAY, SUITE 250
FORT WAYNE, IN 468021412
2604232675
Source: CMS National Downloadable File, September 2026.