Healthcare Provider Details

I. General information

NPI: 1407010572
Provider Name (Legal Business Name): NATHAN DANIEL COMSIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 W JEFFERSON BLVD STE 110
FORT WAYNE IN
46804-4159
US

IV. Provider business mailing address

7910 W JEFFERSON BLVD STE 110
FORT WAYNE IN
46804-4159
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-4116
  • Fax: 260-459-2504
Mailing address:
  • Phone: 260-436-4116
  • Fax: 260-459-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01070963A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: