Individual
SESHADRI JAGANNATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 672-6620
(260) 672-6639
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01075994A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001271412
ANTHEM
IN
05
—
201327590
—
IN
Enumeration date
07/15/2011
Last updated
10/07/2022
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