Healthcare Provider Details

I. General information

NPI: 1386331155
Provider Name (Legal Business Name): FATEMA MAHJABEEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 W 38TH ST
INDIANAPOLIS IN
46254-2995
US

IV. Provider business mailing address

PO BOX 637764
CINCINNATI OH
45263-7764
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-3838
  • Fax: 317-880-0081
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 Number01101081A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: