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NPI Code Detail

MEDICARE: JOHN ADDO MD

MEDICARE: JOHN ADDO 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
1208D00000XGeneral Practice Physician01044290AIN
2207R00000XInternal Medicine Physician01044290IN

Other Identifiers

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

General Provider Information

NPI Number : 1922063189
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN ADDO MD
Provider Business Mailing Address
First Line : 2622 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5410
Country : US
Telephone Number : 260-425-3100
Fax Number : 260-425-3604
Provider Business Practice Location Address
First Line : 2622 LAKE AVE
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-5410
Country : US
Telephone Number : 260-425-3100
Fax Number : 260-425-3604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 09/23/2020

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Directions to “ JOHN ADDO MD” Practice Location

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