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Contact Information

SYED R MUMTAZ, MD
909 E STATE BLVD
FORT WAYNE, IN46805-3404
 Phone: 260-481-2700
 Fax: 260-481-2717
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Child & Adolescent Psychiatry

2084P0804X 86 Physician/Neuropsychiatry
Indicates primary specialty

NPI Profile & details for SYED R MUMTAZ · (Male)

NPI # 1396718573
Status Active
Credentials MD
Entity Individual
Enumeration date 02/09/2006
Last updated 04/23/2012 - About 14 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 01049582A
  • IN Medicaid 200224110
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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