Individual
MOHAN M MENON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3030 LAKE AVE, SUITE 27, FORT WAYNE, IN 46805-5428
(260) 422-5569
(260) 422-6086
Mailing address
1234 E. DUPONT RD., SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9728
(260) 458-5664
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
01028503A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100054450
—
IN
Enumeration date
09/24/2006
Last updated
08/13/2012
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