Provider Demographics
NPI:1063475853
Name:SAVARIAR, LOURDU S (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDU
Middle Name:S
Last Name:SAVARIAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2814 THEATER AVE
Practice Address - Street 2:PEDIATRIC MEDICAL GROUP INC
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-7978
Practice Address - Country:US
Practice Address - Phone:260-356-3611
Practice Address - Fax:260-358-4263
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043689A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01043689AOtherLICENSE
IN200039690AMedicaid
G07912Medicare UPIN
IN200039690AMedicaid