MEDICARE: ALLIED PHYSICIANS INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician
2	2084V0102X	Vascular Neurology Physician
3	363L00000X	Nurse Practitioner
4	163W00000X	Registered Nurse
5	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician
6	2084N0400X	Neurology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CC1549	OTHER	IN	RAILROAD MEDICARE

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609867605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIED PHYSICIANS INC

Provider Business Mailing Address
First Line	:	7956 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4140
Country	:	US
Telephone Number	:	260-436-2416
Fax Number	:	260-436-9662

Provider Business Practice Location Address
First Line	:	2510 E DUPONT RD STE 226
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1603
Country	:	US
Telephone Number	:	260-460-3100
Fax Number	:	260-460-3130

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ISA S CANAVATI
Credential	:	M.D.
Telephone Number	:	260-436-2416

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	12/07/2018

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Directions to “ALLIED PHYSICIANS INC ” Practice Location

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