Organization
FORT WAYNE MEDICAL INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HASSAN TAKI MD (OWNER)
(260) 483-4433
Entity
Organization
Contact information
Practice address
4424 E STATE BLVD, FORT WAYNE, IN 46815-6917
(260) 483-4433
(260) 483-4223
Mailing address
4424 E STATE BLVD, FORT WAYNE, IN 46815-6917
(260) 483-4433
(260) 483-4223
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01042585
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0963453
—
OH
01
—
1114911807
PROVIDER NPI
—
Enumeration date
02/14/2008
Last updated
12/22/2020
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