Healthcare Provider Details

I. General information

NPI: 1952523508
Provider Name (Legal Business Name): ABOITE PODIATRY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7559 WEST JEFFERSON BLVD
FORT WAYNE IN
46804-4131
US

IV. Provider business mailing address

7559 WEST JEFFERSON BLVD
FORT WAYNE IN
46804-4131
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-3579
  • Fax: 260-459-0287
Mailing address:
  • Phone: 260-436-3579
  • Fax: 260-459-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number07000636A
License Number StateIN

VIII. Authorized Official

Name: DR. LYNN H STAFFORD
Title or Position: PRESIDENT
Credential: DPM
Phone: 260-436-3579