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

Dr. Keith David Clancy, MD

Individual provider Surgery Physician · NPI 1164482303

Dr. Keith David Clancy, MD is a General Surgery in Fort Wayne, Indiana. Graduated from Creighton University School of Medicine in 1992, 34 years ago. Practices with Florida Trauma Services LLC, a 93-clinician group and accepts Medicare assignment. Licensed in Illinois, Indiana, Ohio and Pennsylvania.

Years since qualifying
34
Trained at
Creighton University School of Medicine
Licensed in
IL, IN, OH, PA
In the registry since
2006
Specialties on file
10
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

7900 W Jefferson Blvd Ste 306
Fort Wayne, IN 46804-4128
Phone: (260) 458-3610
Fax: (260) 458-3611
Show map & directions

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

Specialties & licences

Trauma Surgery Physician (primary) Taxonomy 2086S0127X · Licence 01079569A (IN)
Surgery Physician Taxonomy 208600000X · Licence MD067578-L (PA)
Surgery Physician Taxonomy 208600000X · Licence 036.090092 (IL)
Surgery Physician Taxonomy 208600000X · Licence 35.123491 (OH)
Surgery Physician Taxonomy 208600000X · Licence 01079569A (IN)
Surgical Critical Care Physician Taxonomy 2086S0102X · Licence MD067578-L (PA)
Surgical Critical Care Physician Taxonomy 2086S0102X · Licence 35.123491 (OH)
Trauma Surgery Physician Taxonomy 2086S0127X · Licence 036.090092 (IL)
Trauma Surgery Physician Taxonomy 2086S0127X · Licence MD067578-L (PA)
Trauma Surgery Physician Taxonomy 2086S0127X · Licence 35.123491 (OH)

Record details

NPI number1164482303
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 23, 2006
Last updated in NPPESSeptember 23, 2020
Certification dateSeptember 23, 2020
Mailing address6920 Pointe Inverness Way Ste 200, Fort Wayne, IN 46804-7934

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGENERAL SURGERY
Medical schoolCREIGHTON UNIVERSITY SCHOOL OF MEDICINE
Graduated 1992 (34 years in practice)
Group practice Florida Trauma Services Llc — 93 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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