Provider Demographics
NPI:1144368382
Name:MIDDLEBURY FAMILY PHYSICIANS, INC
Entity type:Organization
Organization Name:MIDDLEBURY FAMILY PHYSICIANS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WENDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-825-2146
Mailing Address - Street 1:501 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46543-7711
Mailing Address - Country:US
Mailing Address - Phone:574-642-4550
Mailing Address - Fax:574-642-4877
Practice Address - Street 1:501 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:46543-7711
Practice Address - Country:US
Practice Address - Phone:574-642-4550
Practice Address - Fax:574-642-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDE5884OtherR/R MEDICARE
INDE5884OtherR/R MEDICARE