Organization
FORT WAYNE INTEGRATIVE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VISHAAL VEERULA MD (MEDICAL DIRECTOR)
(260) 475-0772
Entity
Organization
Contact information
Practice address
3919 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6811
(260) 475-0772
Mailing address
3919 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6811
(260) 475-0772
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
05/12/2016
Last updated
04/18/2018
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