Fort Wayne Integrative Medicine

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FORT WAYNE INTEGRATIVE MEDICINE

Practice address

3919 W Jefferson Blvd
Fort Wayne, IN 46804-6811

Phone

(260) 475-0772

NPI assigned

May 12, 2016

Last updated

Apr 18, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Vishaal Veerula, MD

Title

Medical Director

Phone

(260) 475-0772

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1245686989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3919 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046811",
            "telephone_number": "260-475-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046811",
            "telephone_number": "260-475-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT WAYNE INTEGRATIVE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-12",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "VEERULA",
        "authorized_official_first_name": "VISHAAL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "260-475-0772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fort Wayne Family Eyecare
• Fort Wayne Family Eyecare PC
• Fort Wayne Fire Department
• Fort Wayne Gi Pathology Services, PC, Inc.
• Fort Wayne Hearing Center & Audiology, Inc. (Quality House Hearing Care Center)
• Fort Wayne Medical Clinic PC
• Fort Wayne Medical Education Program (The Family Medicine Center)
• Fort Wayne Medical Education Program Inc
• Fort Wayne Medical Institute
• Fort Wayne Medical Laboratory Corporation

• Internal Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.