| Blue Crescent Blue Star Medical Of Indiana, Inc | |
|
2326 Hobson Rd Fort Wayne IN 46805-2916 | |
| (859) 823-0000 | |
| Not Available |
| Full Name | Blue Crescent Blue Star Medical Of Indiana, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2326 Hobson Rd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Sundiata M El-amin (OWNER) |
| Authorized Official Contact | 8598230000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Crescent Blue Star Medical Of Indiana, Inc 2326 Hobson Rd Fort Wayne IN 46805-2916 Ph: (859) 823-0000 | Blue Crescent Blue Star Medical Of Indiana, Inc 2326 Hobson Rd Fort Wayne IN 46805-2916 Ph: (859) 823-0000 |
| NPI Number | 1235438185 |
|---|---|
| Provider Enumeration Date | 03/17/2011 |
| Last Update Date | 03/17/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235438185 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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