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NPI Code Detail

MEDICARE: EMILY K RONDOT PAC

MEDICARE: EMILY K RONDOT PAC
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
1363A00000XPhysician Assistant10001025AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000581129OTHERINANTHEM

General Provider Information

NPI Number : 1912153826
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY K RONDOT PAC
Provider Business Mailing Address
First Line : 608 UNION CHAPEL RD STE A
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-9357
Country : US
Telephone Number : 260-482-4440
Fax Number : 260-482-4442
Provider Business Practice Location Address
First Line : 11109 PARKVIEW PLAZA DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number : 260-266-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2008
Last Update Date : 06/16/2026

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Directions to “ EMILY K RONDOT PAC” Practice Location

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