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General NPI Number Information
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NPI Number | 1063517084
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Entity Type | Organization
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Legal Business Name | SUMMIT MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 4656 W JEFFERSON BLVD SUITE 125
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City | FORT WAYNE
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State | IN
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Zip | 46804-6857
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Country | US
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Telephone | 260-434-1177
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Fax | 888-854-6745
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Provider Business Mailing Address
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Address Line | 4656 W JEFFERSON BLVD SUITE 125
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City | FORT WAYNE
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State | IN
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Zip | 46804-6857
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Country | US
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Telephone | 260-434-1177
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Fax | 888-854-6745
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Authorized Official
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Title or Position | OWNER
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Name | DR. BHAKTAVATSALA R APURI
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Credential | M.D.
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Telephone | 260-434-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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