Miroslaw A Foltyniak, M.D. – Surgery Physician

Key facts

NPI: 1790767085
Entity type: Individual (NPI type 1)
Primary specialty: Surgery Physician 208600000X
License: 01038834 (IN)
Practice address: 213 Fairview Blvd
Kendallville, IN 46755-2988
Phone: (260) 347-4900
Fax: (260) 347-4966
NPI assigned: Nov 14, 2005
Sex: Male
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
01038834	IN	MD	Surgery Physician

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Surgery Physician	208600000X	01038834	IN	Yes

Addresses

Primary practice location

213 Fairview Blvd
Kendallville, IN 46755-2988

Mailing address

1234 E. Dupont Rd.
Suite 1
Fort Wayne, IN 46825-1545
Phone (260) 373-9700

Other identifiers

Identifier	Type	State	Issuer
100190980	Medicaid	IN
P00717118	Other	IN	MEDICAIRE RAILROAD
000000605424	Other	IN	ANTHEM

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 20, 2013.

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363737600000",
    "number": "1790767085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 E. DUPONT RD.",
            "address_2": "SUITE 1",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251545",
            "telephone_number": "260-373-9700",
            "fax_number": "260-373-9740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 FAIRVIEW BLVD",
            "city": "KENDALLVILLE",
            "state": "IN",
            "postal_code": "467552988",
            "telephone_number": "260-347-4900",
            "fax_number": "260-347-4966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOLTYNIAK",
        "first_name": "MIROSLAW",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2013-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01038834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100190980",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAIRE RAILROAD",
            "identifier": "P00717118",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000605424",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kendallville, IN

All providers in Kendallville, IN · Surgery Physician in Indiana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2013. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.