Healthcare Provider Details

I. General information

NPI: 1750031357
Provider Name (Legal Business Name): MOHAMMAD MOIZZ AKHTAR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOHAMMAD MOIZZ AKHTAR D.O.

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ESKENAZI AVE # F2-600
INDIANAPOLIS IN
46202-5173
US

IV. Provider business mailing address

640 ESKENAZI AVE # F2-600
INDIANAPOLIS IN
46202-5173
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-5570
  • Fax:
Mailing address:
  • Phone: 317-278-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11025110A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: