Individual
MANOHAR GAJJELA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845
(606) 726-6620
(260) 672-6639
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01081675A
IN
208M00000X
Hospitalist Physician
77792
MD
282N00000X
General Acute Care Hospital
77792
MD
Other
Enumeration date
06/06/2011
Last updated
10/12/2022
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