Healthcare Provider Details

I. General information

NPI: 1104269703
Provider Name (Legal Business Name): ABDUL REHMAN RISHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 DR MARTIN LUTHER KING JR ST
INDIANAPOLIS IN
46208-5019
US

IV. Provider business mailing address

PO BOX 637764
CINCINNATI OH
45263-7764
US

V. Phone/Fax

Practice location:
  • Phone: 317-931-4300
  • Fax: 317-822-5501
Mailing address:
  • Phone: 317-880-3939
  • Fax: 317-880-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019024576
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: