License holder summary

Northeast Indiana Pediatric is a Medical Licensing Board - Medical Corporation licensed to practice in Indiana. The address on file for Northeast Indiana Pediatric is SPECIALISTS P C MED BUILDING 1, 7900 W JEFFERSON BLVD #308, FORT WAYNE IN 46804. This licensed professional license is not current. The license was granted 06/17/1999 and expired on 01/31/2014.

Indiana

Professional Licensing Agency

Northeast Indiana Pediatric
Medical Licensing Board - Medical Corporation
License number
50004150A
Date granted
06/17/1999
Date expires
01/31/2014
Class
Medical Licensing Board - Medical Corporation
Status
Expired
Address
SPECIALISTS P C MED BUILDING 1, 7900 W JEFFERSON BLVD #308, FORT WAYNE IN 46804
indianalicensing.org
ID 24826828
LAST UPDATED 2026-04-19 02:28:45 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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