OrganizationActive
Interdisciplinary Diagnostic and Evaluation Center, Inc.
NPI 1093938102 · Developmental Disabilities Clinic/Center · Fort Wayne, IN
Provider details
- NPI number
- 1093938102
- Entity type
- Organization
- Primary specialty
- Developmental Disabilities Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Marilyn Nathan, Clinical Director(765) 284-9573
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
3030 Lake Ave
Suite 7
Fort Wayne, IN 46805-5428
Phone: (260) 422-2838
Approximate (ZIP-level) locationGet directions
Mailing address
3030 Lake Ave
Fort Wayne, IN 46805-5428
Registry dates
- Enumerated
- 2007-04-10
- Last updated
- 2008-06-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.