Healthcare Provider Details

I. General information

NPI: 1043879802
Provider Name (Legal Business Name): JAMAL SARI ARMOUSH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E HANNA AVE
INDIANAPOLIS IN
46227-3630
US

IV. Provider business mailing address

1400 E HANNA AVE
INDIANAPOLIS IN
46227-3630
US

V. Phone/Fax

Practice location:
  • Phone: 812-890-7086
  • Fax:
Mailing address:
  • Phone: 812-890-7086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: