Healthcare Provider Details

I. General information

NPI: 1669913745
Provider Name (Legal Business Name): KARI INNENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W FOX RIDGE LN
MUNCIE IN
47304-6364
US

IV. Provider business mailing address

7735 W JEFFERSON BLVD STE C
FORT WAYNE IN
46804-4135
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-3886
  • Fax: 765-288-3884
Mailing address:
  • Phone: 260-483-5219
  • Fax: 260-484-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO005653
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: