Individual
DR. SURESH JAISWAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 672-6620
(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
01068162
IN
208M00000X
Hospitalist Physician
01067688A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000659796
ANTHEM
IN
05
—
200980790
—
IN
01
—
P00867138
RAILROAD MEDICARE
IN
Enumeration date
08/27/2009
Last updated
10/20/2022
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