Individual
DR. NATHAN KYLE ALLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805
(260) 373-4000
(260) 482-4442
Mailing address
608 UNION CHAPEL RD, FORT WAYNE, IN 46845-9357
(260) 482-5091
(260) 498-2029
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01060499A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000031002
MPLAN
—
01
—
000000364924
ANTHEM
IN
05
—
104874445
—
MI
05
—
200519770
—
IN
05
—
2571560
—
OH
Enumeration date
08/09/2005
Last updated
11/14/2024
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