Healthcare Provider Details

I. General information

NPI: 1831060862
Provider Name (Legal Business Name): SAMREEN BASRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 NAAB RD
INDIANAPOLIS IN
46260-5918
US

IV. Provider business mailing address

13840 OAK RIDGE RD
CARMEL IN
46032-1227
US

V. Phone/Fax

Practice location:
  • Phone: 317-871-7308
  • Fax:
Mailing address:
  • Phone: 574-855-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number50001087A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: