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

Keith J. Derickson, MD

Individual provider Family Medicine Physician · NPI 1538480439

Keith J. Derickson, MD is a Family Practice in Fort Wayne, Indiana. Graduated from Indiana University School of Medicine in 2010, 16 years ago. Practices with Lutheran Medical Group LLC, a 250-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Indiana.

Years since qualifying
16
Trained at
Indiana University School of Medicine
Licensed in
IN
In the registry since
2010
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

6404 Rothman Rd
Fort Wayne, IN 46835-1366
Phone: (260) 486-6197
Fax: (260) 486-9862
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 01070470A (IN)

Record details

NPI number1538480439
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 15, 2010
Last updated in NPPESSeptember 28, 2020
Certification dateSeptember 28, 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 specialtyFAMILY PRACTICE
Medical schoolINDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduated 2010 (16 years in practice)
Group practice Lutheran Medical Group Llc — 250 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations5 on file with Medicare

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