Provider Demographics
NPI:1659362200
Name:ACKER, HERBERT KJ (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:KJ
Last Name:ACKER
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 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:MEDPARTNERS, ATTTN: MEGAN FORTNEY
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3515
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:3534 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-1361
Practice Address - Country:US
Practice Address - Phone:260-478-5100
Practice Address - Fax:260-478-5213
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01020628A207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100318010Medicaid
INM400048067Medicare PIN
IN100318010Medicaid
000000091884OtherBLUE CROSS BLUE SHIELD
IN080121948OtherRAILROAD MEDICARE
1008OtherPHYSICIANS HEALTH PLAN
B28077Medicare UPIN
IN925500AMedicare PIN
IN925510RMedicare PIN