Healthcare Provider Details

I. General information

NPI: 1407429269
Provider Name (Legal Business Name): TESEIR NAWAF HAMDANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W MICHIGAN ST
INDIANAPOLIS IN
46202-5209
US

IV. Provider business mailing address

1448 10TH AVE STE 304
HUNTINGTON WV
25701-3579
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-7826
  • Fax:
Mailing address:
  • Phone: 304-691-6381
  • Fax: 304-691-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number36435
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: