Individual
DR. KIAN PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 200, FORT WAYNE, IN 46845-1714
(260) 425-6030
(260) 425-6028
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01031156A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082086
ANTHEM BC/BC
IN
05
—
100323160A
—
IN
01
—
1709
PHP
IN
Enumeration date
07/07/2005
Last updated
03/09/2023
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