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

Great Lakes Pediatric Surgeons, Inc

Organization Pediatric Surgery Physician · NPI 1669455267

Great Lakes Pediatric Surgeons, Inc is a Pediatric Surgery Physician in Fort Wayne, Indiana. Registered with an NPI since 2005.

In the registry since
2005
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

7613 W Jefferson Blvd Ste 200
Fort Wayne, IN 46804-4182
Phone: (260) 469-7337
Fax: (260) 469-7340
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Surgery Physician (primary) Taxonomy 2086S0120X

Record details

NPI number1669455267
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official David Smith — President · (260) 469-7337
NPI enumeratedNovember 29, 2005
Last updated in NPPESMarch 14, 2008
Mailing address7613 W Jefferson Blvd Ste 200, Fort Wayne, IN 46804-4182

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