Most Relevant Information
Provider Data
| NPI Number: | 1003591041 |
| Provider Name: | MALLIKA GYAWALI MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/19/2023 |
| Last Updated: | 09/26/2023 |
Provider Practice Location
2200 RANDALLIA DR
FORT WAYNE
IN
468054638
Practice Location Phone/Fax
| Phone: | 2603734000 |
| Fax: |
Provider Mailing Location
2200 RANDALLIA DR
FORT WAYNE
IN
468054638
Provider Mailing Phone/Fax
| Phone: | 2603734000 |
| Fax: |