Provider Demographics
NPI:1316928195
Name:SASSMANNSHAUSEN, JEFFREY WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WALTER
Last Name:SASSMANNSHAUSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7140
Mailing Address - Country:US
Mailing Address - Phone:260-436-9696
Mailing Address - Fax:888-370-2203
Practice Address - Street 1:5650 COVENTRY LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7140
Practice Address - Country:US
Practice Address - Phone:260-436-9696
Practice Address - Fax:888-370-2203
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G14897Medicare UPIN
IN185210Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER