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Individual

JOSHUA MICHAEL WALLET

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
7988 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-0259
(260) 436-0784
Mailing address
2518 E DUPONT RD, FORT WAYNE, IN 46825-1675
(260) 432-4400
(260) 969-6833

Taxonomy

Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
01071141A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201134520
IN
Enumeration date
06/27/2007
Last updated
01/31/2018
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