Healthcare Provider Details

I. General information

NPI: 1174256788
Provider Name (Legal Business Name): PRIYA HOTWANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PRIYA HOTWANI MD

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 RANDALLIA DR
FORT WAYNE IN
46805-4638
US

IV. Provider business mailing address

5210 STONEHEDGE BLVD
FORT WAYNE IN
46835-4802
US

V. Phone/Fax

Practice location:
  • Phone: 260-341-5598
  • Fax:
Mailing address:
  • Phone: 260-341-5598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11022611A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: