Healthcare Provider Details

I. General information

NPI: 1578454369
Provider Name (Legal Business Name): KIRAN INAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

6551 W LONE CACTUS DR
GLENDALE AZ
85308-6418
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-4343
  • Fax:
Mailing address:
  • Phone: 724-544-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11025081A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: