Healthcare Provider Details

I. General information

NPI: 1215460316
Provider Name (Legal Business Name): DEYA MOHAMMAD OBAIDAT M.B.B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 SOUTHPOINTE DR STE A1
INDIANAPOLIS IN
46227-0805
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-4386
  • Fax: 765-203-5213
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number01087384A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: