MEDICARE: SUMMIT ALLERGY INC

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	207K00000X	Allergy & Immunology Physician	01055513A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000600333	OTHER	IN	ANTHEM BC/BS PIN

General Provider Information

NPI Number	:	1407096167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT ALLERGY INC

Provider Business Mailing Address
First Line	:	7030 POINTE INVERNESS WAY STE 335
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7929
Country	:	US
Telephone Number	:	260-969-0801
Fax Number	:	260-969-0802

Provider Business Practice Location Address
First Line	:	7030 POINTE INVERNESS WAY STE 335
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7929
Country	:	US
Telephone Number	:	260-969-0801
Fax Number	:	260-969-0802

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELIZABETH ISBISTER
Credential	:	M.D.
Telephone Number	:	260-969-0801

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	08/19/2014

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Directions to “SUMMIT ALLERGY INC ” Practice Location

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