Organization
INDIANA MEDICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOWELL TESKA (CEO)
(260) 969-7100
Entity
Organization
Contact information
Practice address
7900 W JEFFERSON BLVD, SUITE 201, FORT WAYNE, IN 46804-4128
(260) 969-7100
(260) 969-7101
Mailing address
7900 W JEFFERSON BLVD, SUITE 201, FORT WAYNE, IN 46804-4128
(260) 969-7100
(260) 969-7101
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200190390
—
IN
05
—
200250290
—
IN
05
—
2042720
—
OH
Enumeration date
06/15/2006
Last updated
01/05/2010
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