Organization
REGEN MED OF INDIANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONNA B. CHALFANT (MANAGER)
(260) 482-2206
Entity
Organization
Contact information
Practice address
5931 STONEY CREEK DR, FORT WAYNE, IN 46825-4401
(260) 482-2206
(260) 483-3964
Mailing address
5931 STONEY CREEK DR, FORT WAYNE, IN 46825-4401
(260) 482-2206
(260) 483-3964
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
11/14/2018
Last updated
11/14/2018
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