Individual
TONY FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
59930 MYRTLE RD, SOUTH BEND, IN 46614-9217
(574) 409-2455
Mailing address
59930 MYRTLE RD, SOUTH BEND, IN 46614-9217
(574) 409-2455
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
IN
Other
Enumeration date
06/16/2026
Last updated
06/16/2026
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