Healthcare Provider Details

I. General information

NPI: 1730180563
Provider Name (Legal Business Name): DAVID A. TRENKNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11141 PARKVIEW PLAZA DR STE 110
FORT WAYNE IN
46845-1714
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 260-266-9100
  • Fax: 260-266-9101
Mailing address:
  • Phone: 260-436-4116
  • Fax: 260-436-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01031940A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: