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

Fort Wayne Integrative Medicine

Organization Dermatology Physician · NPI 1245686989

Fort Wayne Integrative Medicine is a Dermatology Physician in Fort Wayne, Indiana. Registered with an NPI since 2016.

In the registry since
2016
Specialties on file
2

Practice location Address checks out

3919 W Jefferson Blvd
Fort Wayne, IN 46804-6811
Phone: (260) 475-0772
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Dermatology Physician Taxonomy 207N00000X

Record details

NPI number1245686989
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Vishaal Veerula — Medical Director · (260) 475-0772
NPI enumeratedMay 12, 2016
Last updated in NPPESApril 18, 2018
Mailing address3919 W Jefferson Blvd, Fort Wayne, IN 46804-6811

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