Healthcare Provider Details

I. General information

NPI: 1871196576
Provider Name (Legal Business Name): AHMED JAMAL ELDEIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N. UNIVERSITY BLVD., INDIANAPOLIS, IN 46202
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

550 N. UNIVERSITY BLVD., INDIANAPOLIS, IN 46202
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-3636
  • Fax:
Mailing address:
  • Phone: 571-474-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number01099832A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number01099832A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: