Organization
FORT WAYNE PSYCHIATRY. P. C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PREVESH KUMAR RUSTAGI M. D. (PRESIDENT)
(260) 484-1312
Entity
Organization
Contact information
Practice address
3400 E COLISEUM BLVD, STE 340, FORT WAYNE, IN 46805-1644
(260) 484-1312
(260) 471-0996
Mailing address
3400 E COLISEUM BLVD, STE 340, FORT WAYNE, IN 46805-1644
(260) 484-1312
(260) 471-0996
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100389780A
—
IN
Enumeration date
10/14/2006
Last updated
01/15/2017
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