MEDICARE: ISA S CANAVATI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	01035042A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	140001925	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952308413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISA S CANAVATI MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7956 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4140
Country	:	US
Telephone Number	:	260-436-2416
Fax Number	:	260-436-6936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/13/2025

Similar Medicare Providers

1245198696 — JESSE DOMINGUEZ
Practice Location Address:

7970 W JEFFERSON BLVD
FORT WAYNE, IN
46804-4140

Practice Phone: 260-435-6100
Practice Fax:

1588124739 — SOVIK DE SIRKAR MD
Practice Location Address:

7950 W JEFFERSON BLVD
FORT WAYNE, IN
46804-4140

Practice Phone: 260-434-6015
Practice Fax: 260-434-6433

1457354433 — DR. THOMAS L LAZOFF M.D.
Practice Location Address:

7956 W JEFFERSON BLVD
FORT WAYNE, IN
46804-4140

Practice Phone: 260-458-3640
Practice Fax: 260-479-1819

1760486187 — HEATHER J. WOLFE MD
Practice Location Address:

7950 W JEFFERSON BLVD STE 210
FORT WAYNE, IN
46804-4140

Practice Phone: 260-435-2852
Practice Fax: 260-435-6695

1689671166 — PAUL E. LATER M.D.
Practice Location Address:

7956 W JEFFERSON BLVD
FORT WAYNE, IN
46804-4140

Practice Phone: 260-436-2416
Practice Fax: 260-436-9662

1487651873 — AJAY S GUPTA MD
Practice Location Address:

7956 W JEFFERSON BLVD
FORT WAYNE, IN
46804-4140

Practice Phone: 260-436-2416
Practice Fax: 260-436-9662

Directions to “ ISA S CANAVATI MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.