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General NPI Number Information
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NPI Number | 1659549475
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Entity Type | Organization
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Legal Business Name | FORT WAYNE MEDICAL INSTITUTE
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 4424 E STATE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46815-6917
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Country | US
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Telephone | 260-483-4433
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Fax | 260-483-4223
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Provider Business Mailing Address
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Address Line | 4424 E STATE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46815-6917
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Country | US
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Telephone | 260-483-4433
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Fax | 260-483-4223
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Authorized Official
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Title or Position | OWNER
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Name | DR. HASSAN TAKI
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Credential | MD
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Telephone | 260-483-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01042585
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License Number State | IN
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