Individual
VAHID-DAVID SEDAGHAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3512 STELLHORN RD, FORT WAYNE, IN 46815-4631
(260) 483-9081
(260) 483-9196
Mailing address
330 N WABASH AVE STE G-20, MARION, IN 46952-2605
(765) 660-7600
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01056095A
IN
2080A0000X
Pediatric Adolescent Medicine Physician
01056095A
IN
208M00000X
Hospitalist Physician
01056095A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000659555
ANTHEM
IN
05
—
200398430
—
IN
Enumeration date
11/07/2005
Last updated
10/20/2020
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