| Fort Wayne Neurosurgery | |
|
7956 W Jefferson Blvd Fort Wayne IN 46804-4140 | |
| (260) 436-2416 | |
| Not Available |
| Full Name | Fort Wayne Neurosurgery |
|---|---|
| Speciality | Neurological Surgery |
| Location | 7956 W Jefferson Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Isa S Canavati (PRESIDENT) |
| Authorized Official Contact | 2604362416 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Wayne Neurosurgery 7956 W Jefferson Blvd Fort Wayne IN 46804-4140 Ph: (260) 436-2416 | Fort Wayne Neurosurgery 7956 W Jefferson Blvd Fort Wayne IN 46804-4140 Ph: (260) 436-2416 |
| NPI Number | 1366433369 |
|---|---|
| Provider Enumeration Date | 10/31/2005 |
| Last Update Date | 12/07/2018 |
| Medicare PECOS PAC ID | 5193625846 |
|---|---|
| Medicare Enrollment ID | O20040327000031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366433369 | NPI | - | NPPES |
| 0515955 | Medicaid | OH | |
| 100277310 | Medicaid | IN | |
| 268567100 | Medicaid | FL | |
| CC1548 | Other | IN | RAILROAD MEDICARE |
| Provider Name | Isa S Canavati |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1952308413 PECOS PAC ID: 0840190500 Enrollment ID: I20100811000319 |
| Provider Name | Loi K Phuong |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1841297041 PECOS PAC ID: 1355241910 Enrollment ID: I20101005000236 |
| Provider Name | Jennifer L Ritchie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164880605 PECOS PAC ID: 6709185911 Enrollment ID: I20161020001231 |
| Provider Name | Adrienne M Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366901902 PECOS PAC ID: 1254673015 Enrollment ID: I20190425002523 |
| Provider Name | Shahnawaz Hussain Qureshi |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1861603466 PECOS PAC ID: 6800068420 Enrollment ID: I20190814000226 |
| Provider Name | Sara Mae Stout |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265041016 PECOS PAC ID: 7113338211 Enrollment ID: I20201120001657 |
| Provider Name | Nicholas M Wetjen |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1275502726 PECOS PAC ID: 6507779980 Enrollment ID: I20220607002487 |
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