Individual
THEKKUMKATTIL D JAMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2510 E DUPONT RD, STE 200, FORT WAYNE, IN 46825
(260) 489-6969
(260) 490-3939
Mailing address
1234 E DUPONT RD, SUITE1, FORT WAYNE, IN 46825-1545
(260) 373-7875
(260) 373-9705
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
01034777B
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01034777B
IN
207RP1001X
Pulmonary Disease Physician
Primary
01034777B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000690072
ANTHEM
IN
05
—
100080860
—
IN
Enumeration date
03/24/2006
Last updated
09/25/2013
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