Individual
MANOJ R SURYAWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 460-1481
Mailing address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 460-1481
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01052547A
IN
Other
Enumeration date
08/23/2006
Last updated
07/08/2007
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