Organization
PEDSTAT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GIRIDHAR RAO VEERULA M.D. (OWNER)
(260) 436-7722
Entity
Organization
Contact information
Practice address
3919 W JEFFERSON BLVD, SUITE 2, FORT WAYNE, IN 46804-6811
(260) 436-7722
(260) 459-0012
Mailing address
3919 W JEFFERSON BLVD, SUITE 2, FORT WAYNE, IN 46804-6811
(260) 436-7722
(260) 459-0012
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/01/2006
Last updated
09/07/2007
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