Healthcare Provider Details

I. General information

NPI: 1447229380
Provider Name (Legal Business Name): PULMONARY ASTHMA & ALLERGY CONSULTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 E DUPONT RD STE 200
FORT WAYNE IN
46825
US

IV. Provider business mailing address

2510 E DUPONT RD STE 200
FORT WAYNE IN
46825
US

V. Phone/Fax

Practice location:
  • Phone: 260-489-6969
  • Fax: 260-490-3939
Mailing address:
  • Phone: 260-489-6969
  • Fax: 260-490-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PUSHPOM JAMES
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 260-489-6969