Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Fort Wayne Cardiovascular Surgeon

Organization Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · NPI 1790718765

Fort Wayne Cardiovascular Surgeon is a Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Fort Wayne, Indiana. Licensed in Indiana. Registered with an NPI since 2006.

Licensed in
IN
In the registry since
2006
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Practice location Address checks out

11123 Parkview Plaza Dr Ste 202
Fort Wayne, IN 46845-1707
Phone: (260) 483-6448
Fax: (260) 373-4167
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician (primary) Taxonomy 208G00000X · Licence 50000046A (IN)

Record details

NPI number1790718765
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Douglas Gray — President/Partner · (260) 483-6448
NPI enumeratedJuly 10, 2006
Last updated in NPPESAugust 22, 2020
Mailing address1818 Carew Streeet, Suite 250, Fort Wayne, IN 46805

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