Healthcare Provider Details

I. General information

NPI: 1295083624
Provider Name (Legal Business Name): HOSPITAL CARE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6435 W JEFFERSON BLVD PMB 109
FORT WAYNE IN
46804
US

IV. Provider business mailing address

6435 W JEFFERSON BLVD PMB 109
FORT WAYNE IN
46804-6203
US

V. Phone/Fax

Practice location:
  • Phone: 260-344-4035
  • Fax:
Mailing address:
  • Phone: 260-312-7139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KHURRUM SHAIKH
Title or Position: PRESIDENT
Credential: MD
Phone: 260-312-7139