Individual
ALEXANDER P MATHAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 526-5431
Mailing address
12515 GOLDEN HARVEST DR, CREDENTIALING DEPARTMENT, FORT WAYNE, IN 46845-9031
(217) 714-0220
(260) 387-6194
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01062241A
IN
208M00000X
Hospitalist Physician
01062241
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000485120
ANTHEM
IN
01
—
11589278
CAQH
IN
05
—
200827920
—
IN
05
—
2680111
—
OH
01
—
POO390087
RAILROAD
—
Enumeration date
07/03/2006
Last updated
08/24/2021
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