Individual
KATHRYN CARBONEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11115 PINE BANK CT, FORT WAYNE, IN 46845-1839
(260) 471-3223
(260) 482-3938
Mailing address
11115 PINE BANK CT, FORT WAYNE, IN 46845-1839
(260) 471-3223
(260) 482-3938
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01035262A
IN
Other
Enumeration date
09/25/2006
Last updated
07/08/2007
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