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Individual

DR. PARDHA KANAGALA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3810 NEW VISION DR, FORT WAYNE, IN 46845-1708
(260) 482-1004
(260) 483-7894
Mailing address
3702 NEW VISION DR, BLDG B, FORT WAYNE, IN 46845-1703
(260) 266-8210

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01028077A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000082092
ANTHEM BC/BS
IN
05
100322090A
IN
01
1461
PHP
IN
Enumeration date
07/01/2005
Last updated
11/01/2018
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