Provider Demographics
NPI:1356326292
Name:ENGLE, MICHAEL R (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:ENGLE
Suffix:
Gender:M
Credentials:DO
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:260-266-6013
Mailing Address - Fax:
Practice Address - Street 1:817 TRAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IN
Practice Address - Zip Code:46701-1534
Practice Address - Country:US
Practice Address - Phone:260-373-9590
Practice Address - Fax:260-373-9594
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001193A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000570548OtherANTHEM
IN3937240018OtherMEDICARE DMEPOS
IN000000207839OtherANTHEM
IN100369380Medicaid
00001076614 08OtherUNITED HEALTHCARE
4287896OtherAETNA
IN4567OtherPHYSICIANS HEALTH PLAN
IN000000207839OtherANTHEM
IN4567OtherPHYSICIANS HEALTH PLAN
IN100369380Medicaid
IN069860MMMedicare PIN
IN080177488Medicare PIN