Provider Demographics
NPI:1871585042
Name:PRESTI, CHARLES F (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:PRESTI
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 1:11108 PARKVIEW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1730
Practice Address - Country:US
Practice Address - Phone:260-266-5700
Practice Address - Fax:260-266-5920
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031157A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00846133OtherMEDICARE RAILROAD
OH060071112OtherRR MEDICARE
IN060070570OtherRR MEDICARE
OH06551OtherMEDICAID OH PARAMOUNT
IN000000641095OtherANTHEM
INP00825409OtherR.R. MEDICARE
IN100321300Medicaid
IN193590NMedicare PIN
IN060070570OtherRR MEDICARE
IN4282851Medicare PIN
IN193580OMedicare PIN
OHPR0655249Medicare PIN
IN060070570Medicare PIN
OHP00846133OtherMEDICARE RAILROAD
IN100321300Medicaid
IN264380YMedicare PIN
INP00825409OtherR.R. MEDICARE