Healthcare Provider Details

I. General information

NPI: 1235121377
Provider Name (Legal Business Name): BARBARA NOHINEK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2736 COVINGTON HOLLOW TRL
FORT WAYNE IN
46804-6146
US

IV. Provider business mailing address

2736 COVINGTON HOLLOW TRL
FORT WAYNE IN
46804-6146
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-2519
  • Fax: 260-432-5911
Mailing address:
  • Phone: 260-432-2519
  • Fax: 260-432-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01038262A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: