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Individual

SYED R. MUMTAZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700
(260) 481-2717
Mailing address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700
(260) 481-2717

Taxonomy

Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
01049582A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200224110
IN
Enumeration date
02/09/2006
Last updated
04/23/2012
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