Healthcare Provider Details

I. General information

NPI: 1578011656
Provider Name (Legal Business Name): MUSTAFA QURESHI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 05/04/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10264 NORMANDY WAY
FISHERS IN
46040-1359
US

IV. Provider business mailing address

10264 NORMANDY WAY
FISHERS IN
46040-1359
US

V. Phone/Fax

Practice location:
  • Phone: 818-447-7194
  • Fax:
Mailing address:
  • Phone: 818-447-7194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01085147A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: