Healthcare Provider Details

I. General information

NPI: 1760834147
Provider Name (Legal Business Name): TAKI M RIDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W 10TH ST
INDIANAPOLIS IN
46222-3802
US

IV. Provider business mailing address

1400 W ICE LAKE RD
IRON RIVER MI
49935-9526
US

V. Phone/Fax

Practice location:
  • Phone: 317-636-4400
  • Fax:
Mailing address:
  • Phone: 905-875-4486
  • Fax: 906-265-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01089356A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: