MEDICARE: ANTHONY D DENNIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01062780A	IN

General Provider Information

NPI Number	:	1003946328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY D DENNIS M.D.

Provider Business Mailing Address
First Line	:	11635 COLDWATER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1256
Country	:	US
Telephone Number	:	260-637-1661
Fax Number	:	260-637-1601

Provider Business Practice Location Address
First Line	:	11635 COLDWATER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1256
Country	:	US
Telephone Number	:	260-637-1661
Fax Number	:	260-637-1601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	12/11/2007

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