Healthcare Provider Details

I. General information

NPI: 1407238330
Provider Name (Legal Business Name): ANADIL FAQAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 07/27/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W WALNUT STREET R2 202
INDIANAPOLIS IN
46202-5181
US

IV. Provider business mailing address

950 W WALNUT ST # R2202
INDIANAPOLIS IN
46202-5188
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-6061
  • Fax:
Mailing address:
  • Phone: 317-278-6061
  • 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: