GEORGE T KOLETTIS (NPI# 1295714608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295714608 |
| Entity Type | Individual |
| Full Name | GEORGE T KOLETTIS |
| Credential | M.D. |
| Practice Address |
7601 W Jefferson Blvd Fort Wayne IN 46804-4133 |
| Mailing Address |
Po Box 2526 Fort Wayne IN 46801-2526 |
| Practice Telephone | 2604368686 |
| Practice Fax Number | 2604368585 |
| Mailing Telephone | 2604368686 |
| Mailing Fax Number | 2604368585 |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2016-11-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 01071673A | IN | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 4301062980 | MI | Allopathic & Osteopathic Physicians |
| Y | 207XS0114X |
Orthopaedic Surgery Specialization: Adult Reconstructive Orthopaedic Surgery |
01071673A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 201117660 | 05 | |
| ANTHEM | 000000784327 | 01 | |
| RAILROAD MEDICARE | P01128176 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083177422 | George Robert Kolettis | Student in an Organized Health Care Education/Training Program | 720 Eskenazi Ave, Fob 2nd Floor, Room F2-163, Indianapolis, IN 46202-1357 | 2019-04-11 |
| 1821198490 | George John Kolettis | Specialist | 660 Glades Rd, Suite 460, Boca Raton, FL 33431-6465 | 2006-09-24 |
| Street Address |
7601 W JEFFERSON BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-4133 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497758429 | Fort Wayne Orthopaedics LLC | Orthopaedic Surgery | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2005-05-23 |
| 1801456553 | Elizabeth Schaefer | Specialist/Technologist | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2019-06-15 |
| 1417514480 | Courtney Mangan | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2019-05-24 |
| 1881177798 | Lindsey M. Hertenstein | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-09-07 |
| 1912407099 | Heather Korte | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-02-15 |
| 1902314958 | John Grimshaw | Registered Nurse | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2018-01-11 |
| 1053836882 | Alex Villavicencio | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-08-14 |
| 1841721735 | Abbey K. Bunnell | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-03-23 |
| 1093256950 | Jessica A. Wiedemann | Nurse Practitioner | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2017-03-13 |
| 1245786672 | Abigail Vanlaningham | Physician Assistant | 7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2016-08-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 207XS0114X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Adult Reconstructive Orthopaedic Surgery |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, adult reconstructive orthopaedic surgeons deal with reconstructive procedures such as joint arthroplasty (i.e., hip and knee), osteotomy, arthroscopy, soft-tissue reconstruction, and a variety of other adult reconstructive surgical procedures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407251382 | Thomas A Brady Sports Medicine Ctr | Orthopaedic Surgery | 1010 S Main St, Ste 100, Tipton, IN 46072-9753 | 2014-11-04 |
| 1639340672 | Stephen F. Mitros, M.d., P.C. | Orthopaedic Surgery | 720 Cedar St Ste 160, South Bend, IN 46617-2093 | 2008-03-18 |
| 1871550053 | John Hur | Orthopaedic Surgery | 201 Pennsylvania Parkway, Suite 100, Indianapolis, IN 46280-1393 | 2006-04-29 |
| 1215440334 | Matthieu Zingg | Orthopaedic Surgery | 13000 E 136th St, Fishers, IN 46037-9478 | 2017-11-10 |
| 1043625361 | Phillip Bostian | Orthopaedic Surgery | 1801 N Senate Blvd Ste 535, Indianapolis, IN 46202-1204 | 2014-06-25 |
| 1518143163 | St. Francis Hospital and Health Centers | Orthopaedic Surgery | 701 E County Line Rd, Suite 204, Greenwood, IN 46143-1072 | 2008-01-14 |
| 1356547095 | Sakkapol Ongwijitwat | Orthopaedic Surgery | 7930 N Shadeland Ave, Indianapolis, IN 46250-2041 | 2007-06-21 |
| 1982770160 | Charles Leo Tremaine | Orthopaedic Surgery | 1950 45th Ave, Suite 200, Munster, IN 46321-3927 | 2006-11-28 |
| 1336101062 | Timothy J Williams | Orthopaedic Surgery | 1199 Hadley Rd, Mooresville, IN 46158-1788 | 2006-04-06 |
| 1083675656 | Joint Replacement Surgeons of Indiana | Orthopaedic Surgery | 1199 Hadley Rd, Mooresville, IN 46158-1788 | 2006-03-31 |
| Find all providers with the same taxonomy | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.