MELVIN SUSANTO

FORT WAYNE, IN
NPI1558939629
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: IN  01091229A)
Enumeration Date2021-06-15
Last Update Date2024-09-09
Business Address
MELVIN SUSANTO MD
12404 LIMA CROSSING DR
FORT WAYNE, IN 46818-0202
Phone number: 260-458-3740
Mailing Address
MELVIN SUSANTO MD
6920 POINTE INVERNESS WAY STE 200
FORT WAYNE, IN 46804-7934
Phone number: 260-458-3740
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