Individual
DR. JOHN PAUL MAGNO MANALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
Mailing address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
125059860
IL
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
01078326A
IN
Other
Enumeration date
06/22/2011
Last updated
02/10/2020
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