Dominick Detommaso is a Podiatrist based in Fort Wayne, IN. Dominick Detommaso practices in Fort Wayne, IN and has the professional credentials of DPM. The NPI Number for Dominick Detommaso is 1013910041 and holds a License No. 07000410A (Indiana).
The current practice location address for Dominick Detommaso is 7601 W Jefferson Blvd, Fort Wayne, IN and can be reached out via phone at 260-436-8686 and via fax at 260-436-8585. You can also correspond with Dominick Detommaso through the mailing address at 7601 W JEFFERSON BLVD, FORT WAYNE, IN - 46804-4133 (mailing address contact number: 260-436-8686).
Location: 7601 W Jefferson Blvd, Fort Wayne, IN, 46804-4133
Provider Profile Details
NPI Number
1013910041
Provider Name
Dominick Detommaso
Credential
DPM
Provider Entity Type
Individual
Gender
Male
Address
7601 W Jefferson Blvd, Fort Wayne, IN, 46804-4133
Phone Number
260-436-8686
Fax Number
260-436-8585
Provider Enumeration Date
05/23/2005
Last Update Date
03/22/2016
Provider's Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000089407 | 01 | ANTHEM | |
| 100053980A | 05 | IN | |
| 200021084 | 01 | RAILROAD MEDICARE |
Provider Business Practice Location Address Details
Address
7601 W Jefferson Blvd
City
State
Zip
46804-4133
Phone Number
260-436-8686
Fax Number
260-436-8585
Provider Business Mailing Address Details
Address
7601 W Jefferson Blvd
City
State
Zip
46804-4133
Phone Number
260-436-8686
Fax Number
260-436-8585
Provider's Taxonomy Details 1
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
-
Taxonomy
License No.
07000410A (Indiana)
Definition
A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.
Provider's Taxonomy Details 2
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Foot & Ankle Surgery
Taxonomy
License No.
07000410A (Indiana)
Definition
Definition to come...