Individual
ANGELA P LASALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1234 E DUPONT RD STE 3, FORT WAYNE, IN 46825-1545
(260) 672-6590
(260) 672-6599
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01047101
IN
207Q00000X
Family Medicine Physician
Primary
01047101A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200102450A
—
IN
Enumeration date
05/01/2006
Last updated
10/10/2022
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