MEDICARE: KANIKA JAGGI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301103736	MI
2	390200000X	Student in an Organized Health Care Education/Training Program	4301103736	MI
3	207Q00000X	Family Medicine Physician	01076756A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073954962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANIKA JAGGI MD

Provider Business Mailing Address
First Line	:	5717 S ANTHONY BLVD
Second Line	:	SUITE 300
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-3386
Country	:	US
Telephone Number	:	260-425-2690
Fax Number	:	260-425-2691

Provider Business Practice Location Address
First Line	:	5717 S ANTHONY BLVD
Second Line	:	SUITE 300
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-3386
Country	:	US
Telephone Number	:	260-425-2690
Fax Number	:	260-425-2691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	10/01/2020

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Directions to “ KANIKA JAGGI MD” Practice Location

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