Healthcare Provider Details

I. General information

NPI: 1407096167
Provider Name (Legal Business Name): SUMMIT ALLERGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 POINTE INVERNESS WAY STE 335
FORT WAYNE IN
46804-7929
US

IV. Provider business mailing address

7030 POINTE INVERNESS WAY STE 335
FORT WAYNE IN
46804-7929
US

V. Phone/Fax

Practice location:
  • Phone: 260-969-0801
  • Fax: 260-969-0802
Mailing address:
  • Phone: 260-969-0801
  • Fax: 260-969-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number01055513A
License Number StateIN

VIII. Authorized Official

Name: DR. ELIZABETH ISBISTER
Title or Position: OWNER
Credential: M.D.
Phone: 260-969-0801