PRATYUSHA TANTRAVAHI

FORT WAYNE, IN
NPI1295198414
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy207Q00000X Family Medicine
(Licence: IN  02006015A)
Additional Taxonomies207Q00000X Family Medicine
(Licence: IN  02006015)
207Q00000X Family Medicine
(Licence: ND  15769)
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2016-04-04
Last Update Date2022-10-14
Business Address
PRATYUSHA TANTRAVAHI D.O.
11109 PARKVIEW PLAZA DR
FORT WAYNE, IN 46845-1701
Phone number: 260-266-2020
Mailing Address
PRATYUSHA TANTRAVAHI D.O.
11109 PARKVIEW PLAZA DR MAILBOX 117
FORT WAYNE, IN 46845
Phone number: