Healthcare Provider Details

I. General information

NPI: 1447417829
Provider Name (Legal Business Name): ANDRES FAJARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDRES FAJARDO CARBONELL MD

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N SENATE BLVD MPC2 SUITE 3500
INDIANAPOLIS IN
46202-1228
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-0280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number01065981A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: