Individual
DR. SRINIVASAN DEVANATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8028 CARNEGIE BLVD., SUITE 600, FORT WAYNE, IN 46804-5790
(260) 969-7100
(260) 969-7263
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01059028A
IN
207RP1001X
Pulmonary Disease Physician
Primary
01059028
IN
207RS0012X
Sleep Medicine (Internal Medicine) Physician
01059028A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000670561
ANTHEM
IN
05
—
200481860
—
IN
01
—
P00867128
R.R. MEDICARE
IN
Enumeration date
05/05/2006
Last updated
10/17/2022
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