Individual
JANET S. PRENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1270 E STATE ROAD 205 STE 210, SUITE 210, COLUMBIA CITY, IN 46725-8506
(260) 248-9230
(260) 248-9249
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02002526A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000231124
ANTHEM
IN
01
—
000000570549
ANTHEM
IN
01
—
080191000
RAILROAD MEDICARE
IN
01
—
13459
PHYSICIANS HEALTH PLAN
IN
05
—
200410430
—
IN
01
—
3937240002
MEDICARE DMEPOS
IN
01
—
3937240025
MEDICARE DMEPOS
IN
01
—
7658349
AETNA
—
Enumeration date
12/27/2005
Last updated
10/17/2022
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