Individual
VINICIUS TEIXEIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
215 W 4TH ST, MISHAWAKA, IN 46544-1917
(260) 344-4035
Mailing address
6435 W JEFFERSON BLVD PMB 109, FORT WAYNE, IN 46804-6203
(260) 344-4035
(260) 969-9272
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01074265A
IN
2084P0800X
Psychiatry Physician
01074265B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201258370
—
IN
Enumeration date
04/12/2010
Last updated
06/18/2024
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