Individual
JOHN ADDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2622 LAKE AVE, FORT WAYNE, IN 46805-5410
(260) 425-3100
(260) 425-3604
Mailing address
2622 LAKE AVE, FORT WAYNE, IN 46805-5410
(260) 425-3100
(260) 425-3604
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01044290
IN
208D00000X
General Practice Physician
01044290A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200068810
—
IN
Enumeration date
04/19/2006
Last updated
09/23/2020
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