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NPI Code Detail

MEDICARE: DAVID MICHAEL SOBER BCBA

MEDICARE: DAVID MICHAEL SOBER BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-17-27471IN

General Provider Information

NPI Number : 1992211569
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID MICHAEL SOBER BCBA
Provider Business Mailing Address
First Line : 4118 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-1210
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4118 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-1210
Country : US
Telephone Number : 260-373-1050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2017
Last Update Date : 12/19/2017

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