Organization
ALLIED PHYSICIANS INC
Active
Other names
Fort Wayne Neurosurgery
Organization subpart
No
Provider details
NPI number
Authorized official
ISA S CANAVATI MD (PRESIDENT)
(260) 436-2416
Entity
Organization
Contact information
Practice address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-2416
Mailing address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-2416
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
1041C0700X
Clinical Social Worker
—
—
207T00000X
Neurological Surgery Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
2084N0400X
Neurology Physician
—
—
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
—
2084V0102X
Vascular Neurology Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0515955
—
OH
05
—
100277310
—
IN
05
—
268567100
—
FL
01
—
CC1548
RAILROAD MEDICARE
IN
Enumeration date
10/31/2005
Last updated
12/07/2018
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