Healthcare Provider Details

I. General information

NPI: 1134823073
Provider Name (Legal Business Name): TEHAAM WARAICH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE FL 2
INDIANAPOLIS IN
46202-5189
US

IV. Provider business mailing address

PO BOX 637764
CINCINNATI OH
45263-7764
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-7000
  • Fax: 317-880-0526
Mailing address:
  • Phone: 317-880-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP06062
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: