Registry details
Type
Individual
Primary specialty
Internal Medicine, Medical Oncology
Enumerated
Aug 9, 2005
License(s)
01054856A (IN), 01054856A (IN)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2514 E DUPONT RD STE 100 | Fort Wayne, IN 46825-1619 | 260-484-8830 |
| MAILING | PO BOX 749495 | Atlanta, GA 30374-9495 | 855-963-2100 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.