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General NPI Number Information
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NPI Number | 1821276627
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Entity Type | Organization
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Legal Business Name | NORTHEAST INDIANA UROLOGY, P.C.
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Dates
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Enumeration Date | 02/04/2008
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 2217 DUBOIS DR
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City | WARSAW
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State | IN
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Zip | 46580-3212
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Country | US
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Telephone | 260-436-6667
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Fax | 260-469-7437
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Provider Business Mailing Address
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Address Line | 2512 E DUPONT RD STE 100
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City | FORT WAYNE
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State | IN
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Zip | 46825-1609
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Country | US
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Telephone | 260-436-6667
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Fax | 260-469-7437
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN BRINKMAN
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Credential | M.D.
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Telephone | 260-436-6667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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