Healthcare Provider Details

I. General information

NPI: 1881001444
Provider Name (Legal Business Name): SUMONA KABIR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 ENGLE RD.
FORT WAYNE IN
46804-2222
US

IV. Provider business mailing address

7222 ENGLE RD.
FORT WAYNE IN
46804-2222
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-5005
  • Fax: 260-432-6003
Mailing address:
  • Phone: 260-432-5005
  • Fax: 260-432-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number71419-21
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number02086824A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS14773
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02086824A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: