# OBSTETRICS AND GYNECOLOGY ASSOCIATES OF FORT WAYNE PC

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

## Provider details

- **NPI number:** 1598806937
- **Authorized official:** DR. JYOTHIRMAI K REDDY M.D. (PRESIDENT)
- **Authorized official phone:** (260) 459-2113

## Contact information

- **Practice address:** 7802 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4138
- **Practice address phone:** (260) 459-2113
- **Practice address fax:** (260) 459-6625
- **Mailing address:** 7802 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4138
- **Mailing address phone:** (260) 459-2113
- **Mailing address fax:** (260) 459-6625

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/09/2007
- **Last updated:** 05/02/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000091644 | ANTHEM PIN | IN |
| 05 | — | 100082350A | — | IN |
| 01 | — | 1734 | PHP | IN |
| 05 | — | 200141300A | — | IN |