Healthcare Provider Details

I. General information

NPI: 1649478744
Provider Name (Legal Business Name): ALLIED PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE IN
46845-1730
US

IV. Provider business mailing address

11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE IN
46845-1730
US

V. Phone/Fax

Practice location:
  • Phone: 260-460-3100
  • Fax:
Mailing address:
  • Phone: 260-460-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: W BARRY KUNKLE
Title or Position: CEO
Credential:
Phone: 260-399-4704