Detommaso, Dominick

Detommaso, Dominick is an individual health care provider with primary practice located at 7601 W Jefferson Blvd , Fort Wayne IN 46804-4133. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, Podiatric Medicine & Surgery Service Providers / Podiatrist. Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery is his primary health care specialty. Detommaso, Dominick can be contacted via phone (260) 436-8686.

Contact Information

Primary practice address
7601 W Jefferson Blvd Fort Wayne IN 46804-4133
Phone: (260) 436-8686
Fax: (260) 436-8585
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 07000410A Indiana
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 07000410A Indiana

Profile Details

NPI number 1013910041
LBN Legal business name Detommaso, Dominick
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date May 23rd, 2005
Last updated Mar 22nd, 2016 - about 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013910041 NPPES
Indiana MEDICAID 100053980A
Indiana Other 00000089407
Indiana Other 200021084

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