Healthcare Provider Details

I. General information

NPI: 1447372768
Provider Name (Legal Business Name): JOY ELIZABETH STRUBLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N. WALNUT STREET
NORTH MANCHESTER IN
46962
US

IV. Provider business mailing address

6920 POINTE INVERNESS WAY STE 200
FORT WAYNE IN
46804-7934
US

V. Phone/Fax

Practice location:
  • Phone: 260-982-1994
  • Fax: 260-982-9274
Mailing address:
  • Phone: 260-479-3513
  • Fax: 260-479-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01065865A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: