| Doctor Name: | JOHN ADDO |
| NPI Number: | 1922063189 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 01044290A |
| Business Practice Address: | 2622 Lake Ave Fort Wayne, IN - 468055410 |
| Business Phone Number: | 2604253100 |
| Business Fax Number: | 2604253604 |
| Mailing Address: | 2622 Lake Ave, FORT WAYNE |
| State: | IN |
| Postal Code: | 468055410 |
| Phone Number: | 2604253100 |
| Fax Number: | 2604253604 |
| NPI Enumeration Date: | 04/19/2006 |
| NPI Last Update Date: | 03/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 01044290A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |