Individual
DR. DOMINICK DETOMMASO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 436-8585
Mailing address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 436-8585
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
07000410A
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
07000410A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000089407
ANTHEM
—
05
—
100053980A
—
IN
01
—
200021084
RAILROAD MEDICARE
—
Enumeration date
05/23/2005
Last updated
03/22/2016
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