Individual
SHEILA FALLOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 434-7088
(260) 435-7394
Mailing address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 434-6377
(260) 434-6389
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01043979A
IN
208M00000X
Hospitalist Physician
Primary
01043979
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000363549
ANTHEM
IN
05
—
200515420
—
IN
Enumeration date
03/07/2006
Last updated
06/21/2016
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