License holder summary

FORT WAYNE PHYSICAL MEDICINE PC is a Medical Licensing Board - Medical Corporation licensed to practice in Indiana. The address on file for FORT WAYNE PHYSICAL MEDICINE PC is 3027 COVINGTON LAKE DRIVE, Fort Wayne IN 46804. This licensed professional license is not current. The license was granted 03/30/2004 and expired on 01/31/2010.

Indiana

Professional Licensing Agency

FORT WAYNE PHYSICAL MEDICINE PC
Medical Licensing Board - Medical Corporation
License number
50004602A
Date granted
03/30/2004
Date expires
01/31/2010
Class
Medical Licensing Board - Medical Corporation
Status
Expired
Address
3027 COVINGTON LAKE DRIVE, Fort Wayne IN 46804
indianalicensing.org
ID 24826610
LAST UPDATED 2024-03-21 11:55:25 UTC

This website is unaffiliated with the Professional Licensing Agency. Please verify all information directly with the relevant official government authority.

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