Provider Demographics
NPI:1811211154
Name:KOBBA, SAMUEL DOMINIC (NP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:DOMINIC
Last Name:KOBBA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5550 S EAST ST STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1991
Mailing Address - Country:US
Mailing Address - Phone:317-534-4660
Mailing Address - Fax:317-782-4301
Practice Address - Street 1:236 SIMPSON AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-4666
Practice Address - Country:US
Practice Address - Phone:574-293-0052
Practice Address - Fax:574-343-1390
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000742A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily