Basic Information
| Provider Information | |||||||||
| NPI: | 1528529427 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VIRNAVE | ||||||||
| FirstName: | TANVI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 608 UNION CHAPEL RD | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468459357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604982020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2200 RANDALLIA DR | ||||||||
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| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468054638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603734000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2019 | ||||||||
| LastUpdateDate: | 08/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 01086970A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.