Individual
DR. PRANAV KUMAR PANCHATSHARAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
800 BROADWAY STE 200, FORT WAYNE, IN 46802-2149
(260) 458-3410
(260) 425-2881
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 458-3410
(260) 425-2881
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
02007800A
IN
Other
Enumeration date
05/17/2019
Last updated
10/03/2024
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