Individual
DR. HASSAN TAKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4424 E STATE BLVD, FORT WAYNE, IN 46815-6917
(260) 483-4433
(260) 483-4223
Mailing address
4424 E STATE BLVD, FORT WAYNE, IN 46815-6917
(260) 483-4433
(260) 483-4223
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01042585
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000091432
BLUE CROSS/BLUE SHIELD
IN
01
—
1659549475
GROUP NPI
—
01
—
1924
PHYSCIANS HEALTH PLAN
IN
05
—
3000054923
—
IN
Enumeration date
09/08/2005
Last updated
07/26/2022
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