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Individual

ANDREA LEIGH HALLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-2416
(260) 436-9662
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01053486A
IN
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
01053486A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200295410
IN
Enumeration date
07/07/2005
Last updated
09/13/2023
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