Individual
KANIKA JAGGI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5717 S ANTHONY BLVD, SUITE 300, FORT WAYNE, IN 46806-3386
(260) 425-2690
(260) 425-2691
Mailing address
5717 S ANTHONY BLVD, SUITE 300, FORT WAYNE, IN 46806-3386
(260) 425-2690
(260) 425-2691
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01076756A
IN
207Q00000X
Family Medicine Physician
4301103736
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301103736
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201359770
—
IN
Enumeration date
07/09/2013
Last updated
10/01/2020
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