MEDICARE: DR. MARWAN A. MUSTAKLEM

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
1	207R00000X	Internal Medicine Physician	01060426A	IN

General Provider Information

NPI Number	:	1750357513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARWAN A. MUSTAKLEM

Provider Business Mailing Address
First Line	:	2001 W 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1902
Country	:	US
Telephone Number	:	317-338-8507
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 E 116TH ST UNIT 575
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-0369
Country	:	US
Telephone Number	:	317-985-9501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	06/05/2026

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Directions to “ DR. MARWAN A. MUSTAKLEM ” Practice Location

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