Clem John Wegman, MD
Family Medicine in Fort Wayne, IN. Individual provider (NPI-1).
NPI number1366936601
StatusActive
Last updated in NPPESMay 17, 2022
Details
- NPI
- 1366936601
- Entity type
- Individual (NPI-1)
- Name
- Clem John Wegman
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 20, 2018
- Certification date
- May 17, 2022
- Last updated
- May 17, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 01082724A | IN | Yes |
| 207Q00000X | Family Medicine | 11020177A | IN | |
| 208D00000X | General Practice | 01082724A | IN | |
| 208M00000X | Hospitalist | 01082724A | IN |
Practice location
750 Broadway Ste 350Fort Wayne, IN 46802-1412
Phone 260-423-2675 · Fax 260-423-6621
Mailing address
250 N Shadeland AveIndianapolis, IN 46219-4959
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