Individual
LEONARD I MASTBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11123 PARKVIEW PLAZA DR, SUITE 202, FORT WAYNE, IN 46845-1707
(260) 373-4280
(260) 373-4288
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
01041346
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000606758
ANTHEM
IN
05
—
100360850
—
IN
Enumeration date
05/16/2006
Last updated
03/23/2013
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