Basic Information
| Provider Information | |||||||||
| NPI: | 1154445831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERNANDO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 E WOODSIDE ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466141453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742331832 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 E BEARDSLEY AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ELKHART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465143366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742068010 | ||||||||
| FaxNumber: | 5742061236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | 01035623A | IN | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.