Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | 01080570A | IN |
NPI | 1093977639 |
---|---|
Provider Name | Muzammil Mushtaq |
First Address | Fort Wayne, IN 46804-7934 |
Second Address | Fort Wayne, IN 46804-4140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 29/09/2020 |