DR. WIACHESLAW WILLIAM FEDORIW (NPI# 1548349871) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548349871 |
| Entity Type | Individual |
| Full Name | DR. WIACHESLAW WILLIAM FEDORIW |
| Credential | MD |
| Practice Address |
2710 Lake Ave Fort Wayne IN 46805-5412 |
| Mailing Address |
3030 Lake Ave #25a Fort Wayne IN 46805-5428 |
| Practice Telephone | 2603738070 |
| Practice Fax Number | 2603738071 |
| Mailing Telephone | 2604224096 |
| Mailing Fax Number | 2604242551 |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2016-06-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 10137509 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 10013063A | 05 | |
| IN | 10013063 | 05 |
| Street Address |
2710 LAKE AVE |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-5412 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457349201 | Mark C. Dickmeyer | Family Medicine | 2710 Lake Ave, Fort Wayne, IN 46805-5412 | 2005-10-06 |
| 1609437425 | Sherri Sue Albertson | Nurse Practitioner | 2710 Lake Ave, Fort Wayne, IN 46805-5412 | 2019-06-24 |
| 1134555634 | Deborah Abaitey | Pediatrics | 2710 Lake Ave, Fort Wayne, IN 46805-5412 | 2013-09-17 |
| 1568808160 | Kayla Bauman | Nurse Practitioner | 2710 Lake Ave, Fort Wayne, IN 46805-5412 | 2013-05-22 |
| 1174885040 | Brianna M Serbus | Family Medicine | 2710 Lake Ave, Fort Wayne, IN 46805-5412 | 2012-06-15 |
| 1407923451 | Parkview Health System, Inc. | Durable Medical Equipment & Medical Supplies | 2710 Lake Ave, Fort Wayne, IN 46805-5412 | 2006-11-28 |
| 1164409579 | Donald B. Marshall II | Family Medicine | 2710 Lake Ave, Fort Wayne, IN 46805-5412 | 2005-12-28 |
| 1336126895 | Steven J. Mooibroek | Internal Medicine | 2710 Lake Ave, Fort Wayne, IN 46805-5412 | 2005-12-27 |
| 1760469233 | Mark A. Pierce | Internal Medicine | 2710 Lake Ave, Fort Wayne, IN 46805-5412 | 2005-12-27 |
| 1871579441 | Cheryl L. Hess | Family Medicine | 2710 Lake Ave, Fort Wayne, IN 46805-5412 | 2005-12-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| Find all providers in zip 46805 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538554399 | Allison Soldner | Pediatrics | 2810 Dupont Commerce Ct, Fort Wayne, IN 46825 | 2015-03-30 |
| 1689939191 | Katherine Elizabeth Welch | Pediatrics | 3308 Rosewood Dr, Fort Wayne, IN 46804-6110 | 2012-07-10 |
| 1881847721 | William C. Ashman | Pediatrics | 6750 Covington Creek Trail, Fort Wayne, IN 46804 | 2008-10-23 |
| 1114061231 | Lalitha Sayed | Pediatrics | 3030 Lake Ave Ste 10, Fort Wayne, IN 46805-5428 | 2007-02-20 |
| 1013077825 | Lindsay M Ligler | Pediatrics | 2514 E. Dupont Rd, Fort Wayne, IN 46825 | 2006-12-11 |
| 1275546913 | Christopher Philip Tallo | Pediatrics | 2510 East Dupont Road, Suite 236, Fort Wayne, IN 46825 | 2006-08-14 |
| 1982614343 | Lynda K Otto | Pediatrics | 2402 Lake Ave, Fort Wayne, IN 46805-5406 | 2006-08-09 |
| 1013936814 | Michael Philip Dick | Pediatrics | 3898 New Vision Dr, Fort Wayne, IN 46845 | 2006-07-19 |
| 1881678860 | Northeast Indiana Genetic Counseling Center Inc | Pediatrics | 11143 Parkview Plaza Dr, Ste. 311, Fort Wayne, IN 46845-1701 | 2005-12-02 |
| 1932106317 | Jayesh P Patel | Pediatrics | 11115 Parkview Plaza Dr, Fort Wayne, IN 46845-1701 | 2005-06-30 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46805 |
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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.