CURTIS LAKE (NPI# 1750892675) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750892675 |
| Entity Type | Individual |
| Full Name | CURTIS LAKE |
| Practice Address |
11104 Parkview Circle Dr Ste 110 Fort Wayne IN 46845-1673 |
| Mailing Address |
3702 New Vision Dr Bldg B Fort Wayne IN 46845-1703 |
| Practice Telephone | 2604256780 |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2018-01-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 10002398 | IN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
11104 PARKVIEW CIRCLE DR STE 110 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46845-1673 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780681254 | Frances R. Goff | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1730 | 2005-06-30 |
| 1164938007 | Brandon Emry | Registered Nurse | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2017-12-14 |
| 1033651260 | Caitlin Camp | Registered Nurse | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845 | 2016-11-04 |
| 1093102022 | Leah Dickstein | Psychiatry & Neurology | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2015-04-16 |
| 1699196519 | Erin Miles | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2013-12-19 |
| 1164860052 | Jacob Thomas Lutz | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2013-06-13 |
| 1467728378 | Usman Kareem Qadeer | Psychiatry & Neurology | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2012-03-25 |
| 1275806663 | Vivian L Appiarius | Nurse Practitioner | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2012-02-15 |
| 1225321664 | Stephanie Reed Falatko | Neurological Surgery | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845 | 2011-05-18 |
| 1659684488 | Shamir Haji | Internal Medicine | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2010-07-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881154110 | Nancy Jean Ehmke | Clinical Nurse Specialist | 11151 Parkview Plaza Dr, Fort Wayne, IN 46845 | 2019-03-22 |
| 1043703903 | Kara Stackhouse | Nurse Practitioner | 11050 Parkview Plaza Drive, Fort Wayne, IN 46845 | 2018-06-14 |
| 1871082412 | Tara K Jellison | Pharmacist | 11109 Parkview Plaza Drive -- Attn Pharmacy, Fort Wayne, IN 46845 | 2018-05-09 |
| 1578097572 | Forefront Dermatology, S.c. | Dermatology | 4020 New Vision Drive, Fort Wayne, IN 46845 | 2017-04-17 |
| 1811437999 | Jessica Ann Lefever | Behavioral Analyst | 3898 New Vision Dr Ste D, Fort Wayne, IN 46845 | 2017-03-08 |
| 1033668041 | Bhi Home Care, Inc. | In Home Supportive Care | 820 Mill Lake Road, Fort Wayne, IN 46845 | 2016-10-03 |
| 1467814939 | Austin Wyss | Specialist/Technologist | 11130 Parkview Circle Drive, Ft. Wayne, IN 46845 | 2016-03-24 |
| 1154713584 | Ashley Whitcraft | Specialist/Technologist | 11130 Parkview Plaza Drive #4, Fort Wayne, IN 46845 | 2015-02-23 |
| 1275975682 | Lakshmi Mohan Viji Das | Internal Medicine | 11143 Parkview Plaza Dr Ste 311, Fort Wayne, IN 46845 | 2013-07-26 |
| 1336482496 | Mithun Mohana Shenoi | Colon & Rectal Surgery | 11104 Parkview Circle Drive Suite 320, Fort Wayne, IN 46845 | 2013-03-27 |
| Find all providers in zip 46845 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104438944 | Erin R Griffin | Physician Assistant | 5621 Woodshire Dr Apt 5, Fort Wayne, IN 46835-2959 | 2020-08-22 |
| 1821608209 | Rebecca Coker | Physician Assistant | 5137 Truemper Way Apt 5, Fort Wayne, IN 46835-3252 | 2020-07-31 |
| 1114536844 | Amanda Kohl | Physician Assistant | 5429 River Run Trl # 5, Fort Wayne, IN 46825-6039 | 2020-07-29 |
| 1538778352 | Kiersten Michelle Coatney | Physician Assistant | 3924 Taylor Rd Apt 65, Fort Wayne, IN 46804-1945 | 2020-07-28 |
| 1013366905 | Brianna Abbott | Physician Assistant | 1234 E Dupont Rd Ste 7, Fort Wayne, IN 46825 | 2016-06-10 |
| 1972890093 | Megan Bearman | Physician Assistant | 3640 New Vision Dr, Suite A, Fort Wayne, IN 46845-1717 | 2011-07-10 |
| 1114211729 | Joel A Ruetz | Physician Assistant | 7619 W Jefferson Blvd, Fort Wayne, IN 46804-4133 | 2011-06-01 |
| 1568617256 | Parkview Health System Inc | Physician Assistant | 11104 Parkview Circle Dr Ste 320, Fort Wayne, IN 46845-1733 | 2008-11-21 |
| 1841441805 | Brooke B Kutka | Physician Assistant | 2512 East Dupont Rd, Suite 200, Fort Wayne, IN 46825-1609 | 2008-10-08 |
| 1265688808 | Kali E Veness | Physician Assistant | 2930 Lake Ave, Fort Wayne, IN 46805-5416 | 2008-08-14 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46845 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.