Healthcare Provider Details

I. General information

NPI: 1972773893
Provider Name (Legal Business Name): ADAM VON NOFZIGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W HIGH ST
BRYAN OH
43506-1690
US

IV. Provider business mailing address

608 UNION CHAPEL RD
FORT WAYNE IN
46845-9357
US

V. Phone/Fax

Practice location:
  • Phone: 419-636-1131
  • Fax:
Mailing address:
  • Phone: 260-482-4440
  • Fax: 260-482-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01069389A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number99067
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: