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Organization

ALLIED PHYSICIANS INC

Active
Other names
Fort Wayne Neurology
Organization subpart
No

Provider details

NPI number
Authorized official
ISA S CANAVATI M.D. (PRESIDENT)
(260) 436-2416
Entity
Organization

Contact information

Practice address
2510 E DUPONT RD STE 226, FORT WAYNE, IN 46825-1603
(260) 460-3100
(260) 460-3130
Mailing address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-2416
(260) 436-9662

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2084N0400X
Neurology Physician
Primary
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
2084V0102X
Vascular Neurology Physician
363L00000X
Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0515955
OH
05
100277310
IN
01
CC1549
RAILROAD MEDICARE
IN
Enumeration date
10/31/2005
Last updated
12/07/2018
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