Healthcare Provider Details

I. General information

NPI: 1619535945
Provider Name (Legal Business Name): AWFA ZAIN-ABDEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AWFA ZAIN ELABIDIN

II. Dates (important events)

Enumeration Date: 06/02/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CAPITOL AVE # E371
INDIANAPOLIS IN
46202-1218
US

IV. Provider business mailing address

1800 N CAPITOL AVE # E371
INDIANAPOLIS IN
46202-1218
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-0700
  • Fax:
Mailing address:
  • Phone: 317-274-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01091542A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.161120
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01091542A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01091542A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: