Organization
ALLIED PHYSICIANS INC
Active
Other names
Fort Wayne NeuroPsychology
Organization subpart
No
Provider details
NPI number
Authorized official
W BARRY KUNKLE (CEO)
(260) 399-4704
Entity
Organization
Contact information
Practice address
11104 PARKVIEW CIRCLE DR, STE 110, FORT WAYNE, IN 46845-1730
(260) 460-3100
Mailing address
11104 PARKVIEW CIRCLE DR, STE 110, FORT WAYNE, IN 46845-1730
(260) 460-3100
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0515955
—
OH
05
—
100277310
—
IN
01
—
CC1549
RAILROAD MEDICARE
IN
Enumeration date
07/10/2007
Last updated
01/28/2015
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