Healthcare Provider Details

I. General information

NPI: 1851520613
Provider Name (Legal Business Name): MICHAEL T NADER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 11/27/2023
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13121 OLIO RD SUITE 300
FISHERS IN
46037-7237
US

IV. Provider business mailing address

6266 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-1300
  • Fax: 317-621-1310
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02003819A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: