Individual
MALLIKA GYAWALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-4000
Mailing address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-4000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11023223A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/19/2023
Last updated
09/26/2023
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