Healthcare Provider Details

I. General information

NPI: 1144018524
Provider Name (Legal Business Name): TASSAWAR FAROOQ DPM
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10122 E 10TH ST STE 230
INDIANAPOLIS IN
46229-2664
US

IV. Provider business mailing address

2500 STIRLING DR
VALPARAISO IN
46383-8032
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-7356
  • Fax:
Mailing address:
  • Phone: 765-430-5082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number41000505A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: