| Organization Name: | CARDIOVASCULAR ASSOCIATES OF NORTHEASTERN INDIANA LLC |
| NPI Number: | 1083684948 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN CSICSKO (OWNER) |
| Mailing Address: | 7900 W Jefferson Blvd Suite 303 Ft Wayne |
| State: | IN US |
| Postal Code: | 468044128 |
| Phone Number: | 2604366098 |
| Fax Number: | 2604363173 |
| NPI Enumeration Date: | 01/24/2006 |
| NPI Last Update Date: | 11/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |