Provider Demographics
NPI:1407096167
Name:SUMMIT ALLERGY INC
Entity Type:Organization
Organization Name:SUMMIT ALLERGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ISBISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-969-0801
Mailing Address - Street 1:7030 POINTE INVERNESS WAY STE 335
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7929
Mailing Address - Country:US
Mailing Address - Phone:260-969-0801
Mailing Address - Fax:260-969-0802
Practice Address - Street 1:7030 POINTE INVERNESS WAY STE 335
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7929
Practice Address - Country:US
Practice Address - Phone:260-969-0801
Practice Address - Fax:260-969-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055513A207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200950470AMedicaid
IN000000600333OtherANTHEM BC/BS PIN
IN259760Medicare PIN