Individual
MAHENDER REDDY SURAKANTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7806 W JEFFERSON BLVD STE C, FORT WAYNE, IN 46804
(260) 203-4188
Mailing address
10214 CHESTNUT PLAZA DR # 306, FORT WAYNE, IN 46814-8970
(260) 203-4188
(260) 203-5136
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01057700A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200442540A
—
IN
Enumeration date
08/30/2005
Last updated
05/25/2018
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