Individual
MARK D DABAGIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 325, FORT WAYNE, IN 46845-1714
(260) 425-5400
(260) 425-5417
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01050387A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000653551
ANTHEM BC/BS
IN
05
—
200212730
—
IN
01
—
P00829121
ANTHEM BC/BS
IN
Enumeration date
07/29/2005
Last updated
11/15/2022
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