Provider Demographics
NPI:1215948971
Name:MIDWEST FERTILITY SPECIALISTS
Entity type:Organization
Organization Name:MIDWEST FERTILITY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOLODZEJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-571-1637
Mailing Address - Street 1:12188 A N MERIDIAN ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-571-1637
Mailing Address - Fax:317-571-9483
Practice Address - Street 1:2514 EAST DUPONT ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-490-3456
Practice Address - Fax:260-490-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty