Individual
KRISHNA DATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 266-2500
(260) 266-2514
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01061557A
IN
208M00000X
Hospitalist Physician
01061557
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000487981
ANTHEM
IN
05
—
200830440
—
IN
05
—
2679936
—
OH
01
—
P00417461
RAILROAD
—
Enumeration date
08/17/2006
Last updated
03/02/2026
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