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Organization
PREMISE HEALTH OF INDIANA MEDICAL PC
Active
Organization
PREMISE HEALTH OF INDIANA MEDICAL PC
Active
Other names
BAE Systems Fort Wayne IN
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON LEIZMAN MD (PRESIDENT)
(615) 468-6270
Entity
Organization
Contact information
Practice address
4250 AIRPORT EXPY, FORT WAYNE, IN 46809-9643
(260) 434-5053
(260) 434-5413
Mailing address
5500 MARYLAND WAY STE 120, BRENTWOOD, TN 37027-4993
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
—
NULL
Other
Enumeration date
02/01/2021
Last updated
10/29/2024
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