Fort Wayne Dermatology Consultants Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

FORT WAYNE DERMATOLOGY CONSULTANTS INC

Practice address

7881 Carnegie Blvd
Fort Wayne, IN 46804-5792

Phone

(260) 436-8000

Fax

(260) 434-0929

NPI assigned

Jan 15, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michelle Waggoner

Title

Ceo

Phone

(260) 469-1444

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristin Haushalter, MD

  • Dermatology Physician
  • Miami, FL
  • NPI 1396959599
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736899200000",
    "number": "1235940784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7881 CARNEGIE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045792",
            "telephone_number": "260-436-8000",
            "fax_number": "260-434-0929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7881 CARNEGIE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045792",
            "telephone_number": "260-436-8000",
            "fax_number": "260-434-0929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE DERMATOLOGY CONSULTANTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-15",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A",
        "authorized_official_last_name": "WAGGONER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-469-1444"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "15D0974991",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fort Wayne Community Schools
• Fort Wayne Community Schools
• Fort Wayne Counseling Services
• Fort Wayne Custom RX, Inc
• Fort Wayne Dental Group, LLC
• Fort Wayne Dermatology Consultants Inc
• Fort Wayne Doulas, LLC
• Fort Wayne Endocrinology PC
• Fort Wayne Endodontics
• Fort Wayne Endoscopy Center LLC

• Clinical Medical Laboratory in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Medical Laboratory in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.