| Fort Wayne Psychiatry. P. C. | |
|
3400 E Coliseum Blvd Ste 340 Fort Wayne IN 46805-1644 | |
| (260) 484-1312 | |
| (260) 471-0996 |
| Full Name | Fort Wayne Psychiatry. P. C. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3400 E Coliseum Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Prevesh Kumar Rustagi (PRESIDENT) |
| Authorized Official Contact | 2604841312 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Wayne Psychiatry. P. C. 3400 E Coliseum Blvd Ste 340 Fort Wayne IN 46805-1644 Ph: (260) 484-1312 | Fort Wayne Psychiatry. P. C. 3400 E Coliseum Blvd Ste 340 Fort Wayne IN 46805-1644 Ph: (260) 484-1312 |
| NPI Number | 1427148782 |
|---|---|
| Provider Enumeration Date | 10/14/2006 |
| Last Update Date | 01/15/2017 |
| Medicare PECOS PAC ID | 1658348602 |
|---|---|
| Medicare Enrollment ID | O20040910000598 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427148782 | NPI | - | NPPES |
| 100389780A | Medicaid | IN |
| Provider Name | Prevesh K Rustagi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245237411 PECOS PAC ID: 9032186002 Enrollment ID: I20071129000637 |
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