MEDICARE: FORT WAYNE ALLERGY AND ASTHMA CONSULTANTS, 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

General Provider Information

NPI Number	:	1689714727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT WAYNE ALLERGY AND ASTHMA CONSULTANTS, INC.

Provider Business Mailing Address
First Line	:	7920 W JEFFERSON BLVD
Second Line	:	SUITE 220
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4168
Country	:	US
Telephone Number	:	260-436-5670
Fax Number	:

Provider Business Practice Location Address
First Line	:	7920 W JEFFERSON BLVD
Second Line	:	SUITE 220
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4168
Country	:	US
Telephone Number	:	260-436-5670
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LYN WITTWER
Credential	:
Telephone Number	:	260-436-5670

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/22/2020

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