Provider Demographics
NPI:1104827567
Name:WYNDER, STEVEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:WYNDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2003 STULTS RD
Practice Address - Street 2:SUITE 210
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1291
Practice Address - Country:US
Practice Address - Phone:260-355-3110
Practice Address - Fax:260-355-3114
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027903A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000514637OtherANTHEM
OH2147386Medicaid
IN200250720Medicaid
INP00465492OtherMEDICARE RAILROAD
IN200037017OtherRAIL ROAD MEDICARE
IN200037017Medicare PIN
INP00465492OtherMEDICARE RAILROAD
IN200250720Medicaid
IN070860VVMedicare PIN
IN058940KKMedicare PIN