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General NPI Number Information
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NPI Number | 1073954962
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Entity Type | Individual
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Provider Name | KANIKA JAGGI MD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 5717 S ANTHONY BLVD SUITE 300
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City | FORT WAYNE
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State | IN
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Zip | 46806-3386
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Country | US
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Telephone | 260-425-2690
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Fax | 260-425-2691
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Provider Business Mailing Address
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Address Line | 5717 S ANTHONY BLVD SUITE 300
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City | FORT WAYNE
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State | IN
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Zip | 46806-3386
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Country | US
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Telephone | 260-425-2690
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Fax | 260-425-2691
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301103736
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4301103736
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01076756A
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License Number State | IN
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