# REGEN MED OF INDIANA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104395680
- **Authorized official:** TONNA B. CHALFANT (MANAGER)
- **Authorized official phone:** (260) 482-2206

## Contact information

- **Practice address:** 5931 STONEY CREEK DR, FORT WAYNE, IN 46825-4401
- **Practice address phone:** (260) 482-2206
- **Practice address fax:** (260) 483-3964
- **Mailing address:** 5931 STONEY CREEK DR, FORT WAYNE, IN 46825-4401
- **Mailing address phone:** (260) 482-2206
- **Mailing address fax:** (260) 483-3964

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/14/2018
- **Last updated:** 11/14/2018