| Allen County Internal Medicine Pc | |
|
12515 Golden Harvest Dr Fort Wayne IN 46845-9031 | |
| (217) 714-0220 | |
| Not Available |
| Full Name | Allen County Internal Medicine Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12515 Golden Harvest Dr, Fort Wayne, Indiana |
| Authorized Official Name and Position | Rutvik Patel (OWNER) |
| Authorized Official Contact | 2177140220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Allen County Internal Medicine Pc 12515 Golden Harvest Dr Fort Wayne IN 46845-9031 Ph: (217) 714-0220 | Allen County Internal Medicine Pc 12515 Golden Harvest Dr Fort Wayne IN 46845-9031 Ph: (217) 714-0220 |
| NPI Number | 1356755813 |
|---|---|
| Provider Enumeration Date | 06/12/2014 |
| Last Update Date | 06/21/2016 |
| Medicare PECOS PAC ID | 0143447060 |
|---|---|
| Medicare Enrollment ID | O20140815001608 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356755813 | NPI | - | NPPES |
| 201240270 B | Medicaid | IN | |
| 201240270 C | Medicaid | IN | |
| 201240270 D | Medicaid | IN | |
| 201240270 A | Medicaid | IN | |
| 201240270 E | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Ashish Kumar Khemka |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992716179 PECOS PAC ID: 2668376401 Enrollment ID: I20051219000684 |
| Provider Name | Rutvik Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275567166 PECOS PAC ID: 7517963242 Enrollment ID: I20061019000520 |
| Provider Name | Krishna B Datta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427161801 PECOS PAC ID: 0446259576 Enrollment ID: I20061218000518 |
| Provider Name | Alexander Mathai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104856608 PECOS PAC ID: 1759483209 Enrollment ID: I20070301000269 |
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