Detommaso, Jonathan

Detommaso, Jonathan is an sole proprietor 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 / Podiatrist, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery. Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery is his primary health care specialty. Detommaso, Jonathan 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 / Podiatrist 213E00000X 07001204A Indiana
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 07001204A Indiana

Profile Details

NPI number 1033476304
LBN Legal business name Detommaso, Jonathan
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 11th, 2012
Last updated Nov 7th, 2016 - about 9 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 1033476304 NPPES
Indiana Other P01524125 RAILROAD MEDICARE
Indiana MEDICAID 201289140 RAILROAD MEDICARE
Indiana Other 000000934131 RAILROAD MEDICARE

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