Individual
DR. SHOBANA PANDIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10515 ILLINOIS RD, FORT WAYNE, IN 46814
(260) 373-9200
(260) 373-9219
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01058626A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000658068
ANTHEM
IN
01
—
146470C5
MEDICARE
IN
05
—
200856050
—
IN
Enumeration date
02/08/2006
Last updated
11/27/2023
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