PREMISE HEALTH OF INDIANA MEDICAL P.C. NPI 1033700158

NPI Information

PREMISE HEALTH OF INDIANA MEDICAL, P.C. is an occupational medicine clinic center in Fort Wayne, IN. PREMISE HEALTH OF INDIANA MEDICAL, P.C. NPI is 1033700158. The provider is registered as an organization entity type.
The provider Is Doing Business As Bae Systems Fort Wayne In.

The provider's business location address is:

4250 AIRPORT EXPY
FORT WAYNE, IN
ZIP 46809-643
Phone: (260) 434-5053
Fax: (260) 434-5413

The provider's authorized official is Jon Leizman .
The authorized official title is President and has the following contact phone number (216) 479-9063.

The CLIA number assigned to this NPI record is 15D2080384 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/1/2021 and was last updated on 8/25/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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