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6026 E State Blvd Fort Wayne IN 46815-7639 | |
| (260) 749-8419 | |
| (260) 749-0553 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 6026 E State Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Kenneth A. Bundza (PARTNER) |
| Authorized Official Contact | 2607498419 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6026 E State Blvd Fort Wayne IN 46815-7639 Ph: (260) 749-8419 | 6026 E State Blvd Fort Wayne IN 46815-7639 Ph: (260) 749-8419 |
| NPI Number | 1942369194 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942369194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 20010242A (Indiana) | Primary |
| 103T00000X | Psychologist | 20010117A (Indiana) | Secondary |
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