Individual
PRATYUSHA TANTRAVAHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 266-2020
(260) 266-2009
Mailing address
11109 PARKVIEW PLAZA DR, MAILBOX 117, FORT WAYNE, IN 46845
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02006015
IN
207Q00000X
Family Medicine Physician
Primary
02006015A
IN
207Q00000X
Family Medicine Physician
15769
ND
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2016
Last updated
10/14/2022
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