Provider Demographics
NPI:1750326351
Name:KINTANAR, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:KINTANAR
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:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-458-3737
Mailing Address - Fax:260-458-3734
Practice Address - Street 1:10020 DUPONT CIRCLE CT
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1620
Practice Address - Country:US
Practice Address - Phone:260-489-8563
Practice Address - Fax:260-489-8255
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035043A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00970648OtherRAILROAD MEDICARE
IN100080420Medicaid
000000206208OtherBCBS
INP00970648OtherRAILROAD MEDICARE
IN100080420Medicaid
IN185760MMedicare ID - Type Unspecified