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Organization
OBSTETRICS AND GYNECOLOGY ASSOCIATES OF FORT WAYNE PC
Active
Organization
OBSTETRICS AND GYNECOLOGY ASSOCIATES OF FORT WAYNE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JYOTHIRMAI K REDDY M.D. (PRESIDENT)
(260) 459-2113
Entity
Organization
Contact information
Practice address
7802 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4138
(260) 459-2113
(260) 459-6625
Mailing address
7802 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4138
(260) 459-2113
(260) 459-6625
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000091644
ANTHEM PIN
IN
05
—
100082350A
—
IN
01
—
1734
PHP
IN
05
—
200141300A
—
IN
Enumeration date
02/09/2007
Last updated
05/02/2008
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