Individual
KHIN MAR OO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 421-1092
Mailing address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 421-1092
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
01044410A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000081125
ANTHEM
IN
01
—
110123397
RAILROAD MEDICARE
IN
01
—
6664
PHYSICIANS HEALTH PLAN
IL
Enumeration date
08/09/2005
Last updated
05/09/2013
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