Individual
DR. MOHAMED G GENDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7802 W JEFFERSON BLVD STE A, FORT WAYNE, IN 46804-4138
(260) 305-2822
(260) 305-2829
Mailing address
7802 W JEFFERSON BLVD STE A, FORT WAYNE, IN 46804-4138
(260) 305-2822
(260) 305-2829
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01088661A
IN
207W00000X
Ophthalmology Physician
036137626
IL
207W00000X
Ophthalmology Physician
60540
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508183427
—
WI
05
—
300067629
—
IN
01
—
IN5423002
MEDICARE
IN
Enumeration date
05/02/2010
Last updated
12/01/2022
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