Individual
DR. SATYA PRASAD TUMMALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 200, FORT WAYNE, IN 46845-1714
(260) 425-6030
(260) 425-6028
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01054613A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000201978
ANTHEM BC/BS
IN
01
—
12179
PHP
IN
05
—
200357110A
—
IN
Enumeration date
07/01/2005
Last updated
03/06/2023
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