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Fanta Mallard, MEDICALASSISTANT
Independent Medical Examiner Physician in Gary, Indiana
NPI 1598490013

Fanta Mallard is a Independent Medical Examiner Physician based in Gary, IN. Fanta Mallard practices in Gary, IN and has the professional credentials of MEDICALASSISTANT. The NPI Number for Fanta Mallard is 1598490013 and holds a License No. (Indiana).

The current practice location address for Fanta Mallard is 578 Tennessee St, Gary, IN and can be reached out via phone at 312-241-3044.

Location: 578 Tennessee St, Gary, IN, 46402-1438
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1598490013
Provider Name
Fanta Mallard
Credential
MEDICALASSISTANT
Provider Entity Type
Individual
Gender
Female
Address
578 Tennessee St, Gary, IN, 46402-1438
Phone Number
312-241-3044
Fax Number
Provider Enumeration Date
07/19/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
578 Tennessee St
City
Gary
State
Indiana
Zip
46402-1438
Phone Number
312-241-3044
Fax Number
person
Provider Business Mailing Address Details
Address
578 Tennessee St
City
Gary
State
Indiana
Zip
46402-1438
Phone Number
312-241-3044
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Medical Genetics, Ph.D. Medical Genetics
Speciality
-
Taxonomy
170100000X
License No.
M6S9Q7R7 (Indiana)
Definition
A medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program, and serves as a consultant to medical and dental specialists.
person
Provider's Taxonomy Details 2
Type
Other Service Providers
Classification
Driver
Speciality
-
Taxonomy
172A00000X
License No.
()
Definition
A person employed to operate a motor vehicle as a carrier of persons or property.
person
Provider's Taxonomy Details 3
Type
Allopathic & Osteopathic Physicians
Classification
Independent Medical Examiner
Speciality
-
Taxonomy
202C00000X
License No.
()
Definition
A special evaluator not involved with the medical care of the individual examinee that impartially evaluates the care being provided by other practitioners to clarify clinical, disability, liability or other case issues.
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