Organization
FORT WAYNE MEDICAL ONCOLOGY AND HEMATOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRAVEEN KOLLIPARA MD (OWNER)
(260) 969-7868
Entity
Organization
Contact information
Practice address
7910 W JEFFERSON BLVD, STE 108, FORT WAYNE, IN 46804-4159
(260) 484-8830
(260) 483-1911
Mailing address
2514 E DUPONT RD STE 100, FORT WAYNE, IN 46825-1619
(260) 484-8830
(260) 483-1911
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
01/18/2007
Last updated
08/02/2019
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