Individual
KALI E VENESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2930 LAKE AVE, FORT WAYNE, IN 46805-5416
(260) 422-4096
Mailing address
2930 LAKE AVE, FORT WAYNE, IN 46805-5416
(260) 422-4096
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001002A
IN
Other
Enumeration date
08/14/2008
Last updated
01/23/2013
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