Mallard, Fanta

Mallard, Fanta is an sole proprietor health care provider with primary practice located at 578 Tennessee St , Gary IN 46402-1438. She recently has 3 registered licenses in different health care specialties including Other Service Providers / Medical Genetics, Ph.D. Medical Genetics, Other Service Providers / Driver, Allopathic & Osteopathic Physicians / Independent Medical Examiner. Allopathic & Osteopathic Physicians / Independent Medical Examiner is her primary health care specialty. Mallard, Fanta can be contacted via phone (312) 241-3044.

Contact Information

Primary practice address
578 Tennessee St Gary IN 46402-1438
Phone: (312) 241-3044
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Medical Genetics, Ph.D. Medical Genetics 170100000X
Other Service Providers / Driver 172A00000X
Allopathic & Osteopathic Physicians / Independent Medical Examiner 202C00000X M6S9Q7R7 Indiana

Profile Details

NPI number 1598490013
LBN Legal business name Mallard, Fanta
Credentials MEDICAL ASSISTANT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 19th, 2022
Last updated Jul 19th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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