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General NPI Number Information
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NPI Number | 1023198926
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SPECIALTY PHYSICIANS, PC
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 7429 INVERNESS COMMONS
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City | FORT WAYNE
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State | IN
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Zip | 46804-3837
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Country | US
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Telephone | 260-408-5801
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Fax | 888-949-8258
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Provider Business Mailing Address
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Address Line | 7429 INVERNESS COMMONS
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City | FORT WAYNE
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State | IN
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Zip | 46804-3837
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Country | US
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Telephone | 260-408-5801
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Fax | 888-949-8258
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAYESH P PATEL
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Credential | M.D.
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Telephone | 260-408-5801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number |
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License Number State |
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