Individual
MAMATA EAGAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
902 PROVIDENT DRIVE, SUITE A, WARSAW, IN 46580-3379
(574) 269-8338
(574) 269-8339
Mailing address
6920 POINTE INVERNESS WAY, SUITE 200, FORT WAYNE, IN 46804-7934
(260) 479-3513
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
02004718A
IN
208000000X
Pediatrics Physician
Primary
OS14468
FL
Other
Enumeration date
04/22/2008
Last updated
10/10/2019
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