Provider Demographics
NPI:1497738231
Name:ALLIED PHYSICIANS INC., D/B/A EAR, NOSE & THROAT SPECIALISTS
Entity Type:Organization
Organization Name:ALLIED PHYSICIANS INC., D/B/A EAR, NOSE & THROAT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FALLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-484-0919
Mailing Address - Street 1:2516 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1608
Mailing Address - Country:US
Mailing Address - Phone:260-490-8422
Mailing Address - Fax:260-490-5891
Practice Address - Street 1:2516 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1608
Practice Address - Country:US
Practice Address - Phone:260-490-8422
Practice Address - Fax:260-490-5891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN151060Medicare ID - Type Unspecified