Individual
DR. ALIREZA KHONSARI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
710 NORTH EAST STREET, WABASH COUNTY HOSPITAL, WABASH, IN 46992
(260) 569-2240
(260) 569-2380
Mailing address
6119 W JEFFERSON BLVD, FORT WAYNE, IN 46804
(260) 432-1568
(260) 432-4969
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01033004A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136270GG
MEDICARE
IN
Enumeration date
01/27/2006
Last updated
07/08/2007
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