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Individual

DR. SAMPATH KUMAR SANTHANAM ETHIRAJ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.B.B.S

Contact information

Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 672-6620
(260) 672-6639
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01072529A
IN
207R00000X
Internal Medicine Physician
4301092338
MI

Other

Enumeration date
08/20/2008
Last updated
10/03/2022
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