MELVIN SUSANTO

FORT WAYNE, IN
NPI1558939629
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: IN  11021823A)
Enumeration Date2021-06-15
Last Update Date2021-06-15
Business Address
MELVIN SUSANTO MD
750 BROADWAY STE 350
FORT WAYNE, IN 46802-1412
Phone number: 260-423-2675
Mailing Address
MELVIN SUSANTO MD
750 BROADWAY STE 350
FORT WAYNE, IN 46802-1412
Phone number: 260-423-2675
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