Individual
BRANDON BACCARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12404 LIMA CROSSING DR, FORT WAYNE, IN 46818
(260) 478-4201
(260) 458-3293
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02006419A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2019
Last updated
09/07/2022
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