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NPI Code Detail

MEDICARE: BURAQ HOLDING LLC

MEDICARE: BURAQ HOLDING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1184513772
Entity Type Code : Organization
Provider Name (Legal Business Name) : BURAQ HOLDING LLC
Provider Business Mailing Address
First Line : 1849 SUGAR GROVE AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-1132
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2506 E WASHINGTON ST STE 202
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46201-4126
Country : US
Telephone Number : 619-394-2059
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : RABAB BOULASBAA
Credential :
Telephone Number : 619-394-2059
Provider Enumeration Date : 06/30/2025
Last Update Date : 04/28/2026

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Directions to “BURAQ HOLDING LLC ” Practice Location

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