Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO02134 | IN |
N | 222Z00000X | Podiatrist | CPO02134 | IN |
Y | 224P00000X | Prosthetist | CPO02134 | IN |
NPI | 1457892515 |
---|---|
Provider Name | Fred Toenges |
First Address | Fort Wayne, IN 46804-4135 |
Second Address | Fort Wayne, IN 46804-4135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2017 |
Last Update Date | 09/03/2017 |