Provider Demographics
NPI:1689714727
Name:FORT WAYNE ALLERGY AND ASTHMA CONSULTANTS, INC.
Entity Type:Organization
Organization Name:FORT WAYNE ALLERGY AND ASTHMA CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-436-5670
Mailing Address - Street 1:7920 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4168
Mailing Address - Country:US
Mailing Address - Phone:260-436-5670
Mailing Address - Fax:
Practice Address - Street 1:7920 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4168
Practice Address - Country:US
Practice Address - Phone:260-436-5670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
047960Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER