Bellavance, Tracy L
Bellavance, Tracy L is an individual health care provider with primary practice located at 7988 W Jefferson Blvd , Fort Wayne IN 46804-4140. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Bellavance, Tracy L can be contacted via phone (260) 432-4400.Contact Information
Primary practice address
7988 W Jefferson Blvd
Fort Wayne IN 46804-4140
Phone: (260) 432-4400
Fax: (260) 969-6898
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 01046643A | Indiana |
Profile Details
| NPI number | 1588659064 |
|---|---|
| LBN Legal business name | Bellavance, Tracy L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 12th, 2005 |
| Last updated | Jan 31st, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588659064 | NPPES |
| Indiana | MEDICAID | 200126000 |
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