Healthcare Provider Details

I. General information

NPI: 1922359736
Provider Name (Legal Business Name): OWAIS MUFTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 EDISON LAKES PKWY # 100
MISHAWAKA IN
46545-1414
US

IV. Provider business mailing address

5575 DTC PKWY STE 225
GREENWOOD VILLAGE CO
80111-3073
US

V. Phone/Fax

Practice location:
  • Phone: 574-231-6800
  • Fax:
Mailing address:
  • Phone: 303-390-1926
  • Fax: 866-368-6349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301511119
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01086161A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-47453
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01086161A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: