Individual
MANANA GEGESHIDZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
415 E MADISON ST, SOUTH BEND, IN 46617-2322
(574) 283-1234
(574) 537-2652
Mailing address
PO BOX 809, GOSHEN, IN 46527-0809
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01060810A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200527560
—
IN
Enumeration date
07/23/2006
Last updated
03/13/2013
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