Healthcare Provider Details

I. General information

NPI: 1528478997
Provider Name (Legal Business Name): HAMMZAH JOMHA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 NORTH SENATE AVE.
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

1520 NORTH SENATE AVE.
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-8893
  • Fax: 317-962-6722
Mailing address:
  • Phone: 317-962-8893
  • Fax: 317-962-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11017947A
License Number StateIN
# 2
Primary TaxonomyN
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: