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Preeti Nanak Dembla

Internal Medicine

Allopathic & Osteopathic Physicians

11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701

PECOS Enrollment

This provider is enrolled in PECOS as PREETI DEMBLA.

Based on the most recent information from CMS, provider Preeti Nanak Dembla is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1346248051
Provider Type
Individual
Full Name
Dembla, Preeti Nanak
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
7/7/2005
Last Updated
9/12/2022

Contact Information

Practice Location

11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701

(260) 672-6620

(260) 672-6639

Mailing Location

11109 Parkview Plaza Dr # 117, Fort Wayne, IN 46845-1701

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 01066343A Indiana
Code 174400000X	Description Specialist Other Service Providers	License 39332 Tennessee
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License 39332 Tennessee
Code 208M00000X	Description Hospitalist Allopathic & Osteopathic Physicians	License MD0000039332 Tennessee
Code 208M00000X	Description Hospitalist Allopathic & Osteopathic Physicians	License 01066343 Indiana

Provider Identifiers

ID	Description	Issuer
ID 200940150	Description Medicaid	Issuer Unlisted Indiana

Preeti Nanak Dembla

PECOS Enrollment

Profile Details

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