Individual
DR. WADE GARRET KVATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1040 WISHARD BLVD, INDIANAPOLIS, IN 46202-2872
(317) 962-8893
Mailing address
1040 WISHARD BLVD, INDIANAPOLIS, IN 46202-2872
(317) 962-8893
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01086332A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11020093A
IN
Other
Enumeration date
06/14/2018
Last updated
08/12/2022
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