Healthcare Provider Details

I. General information

NPI: 1770614604
Provider Name (Legal Business Name): SHAHROOZ DERMATOLOGY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 450
INDIANAPOLIS IN
46237-8600
US

IV. Provider business mailing address

8051 S EMERSON AVE STE 450
INDIANAPOLIS IN
46237-8600
US

V. Phone/Fax

Practice location:
  • Phone: 317-859-9859
  • Fax: 317-859-3265
Mailing address:
  • Phone: 317-859-9859
  • Fax: 317-859-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01036322A
License Number StateIN

VIII. Authorized Official

Name: DR. NAHID SHAHROOZ
Title or Position: OWNER
Credential: MD
Phone: 317-859-9859