NPI 1033476304 · live from the CMS NPI Registry
Jonathan Detommaso, DPM
Podiatrist, Foot & Ankle Surgery in Fort Wayne, IN. National Provider Identifier 1033476304, active.
NPI record
| NPI | 1033476304 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Podiatrist, Foot & Ankle Surgery 213ES0103X |
| Practice location | 7601 W Jefferson Blvd, Fort Wayne, IN 46804 |
| Practice phone | 260-436-8686 |
| Mailing address | Po Box 2526, Fort Wayne, IN 46801 |
| Enumerated | April 11, 2012 |
| Last updated | November 7, 2016 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist | 213E00000X | 07001204A (IN) |
| Podiatrist, Foot & Ankle Surgery primary | 213ES0103X | 07001204A (IN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.