Organization
EAR, NOSE & THROAT ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENN VAN DER WEELE (CEO)
(260) 207-1675
Entity
Organization
Contact information
Practice address
1169 N MAIN ST, SUITE 5, BLUFFTON, IN 46714-1360
(260) 827-4368
(260) 827-4370
Mailing address
10021 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1604
(260) 426-8117
(260) 420-0817
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
50000001A
IN
Other
Enumeration date
12/22/2005
Last updated
08/22/2020
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