Healthcare Provider Details

I. General information

NPI: 1477967149
Provider Name (Legal Business Name): JASPREET S JAWANDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 BROADWAY STE 165
FORT WAYNE IN
46802-4377
US

IV. Provider business mailing address

245 WAVE ROCK RUN W
FORT WAYNE IN
46845-4516
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-9805
  • Fax: 260-266-9815
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT207428
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01078217A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01078217A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: