Organization
OBSTETRICS AND GYNECOLOGY ASSOCIATES OF FORT WAYNE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JYOTHIRMAI K REDDY M.D. (PRESIDENT)
(260) 459-2113
Entity
Organization
Contact information
Practice address
7802 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4138
(260) 459-2113
(260) 459-6625
Mailing address
7802 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4138
(260) 459-2113
(260) 459-6625
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000091644
ANTHEM PIN
IN
05
—
100082350A
—
IN
01
—
1734
PHP
IN
05
—
200141300A
—
IN
Enumeration date
02/09/2007
Last updated
05/02/2008
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