Individual
DR. MIRIVA MAGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1717 S CALHOUN ST, FORT WAYNE, IN 46802-5257
(260) 458-2641
Mailing address
1717 S CALHOUN ST, FORT WAYNE, IN 46802-5257
(260) 458-2641
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301098894
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B56065054
MEDICARE PTAN
—
Enumeration date
10/16/2008
Last updated
05/10/2017
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