Healthcare Provider Details

I. General information

NPI: 1174887608
Provider Name (Legal Business Name): TAMARA KERMANI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N DAN JONES RD STE 150
PLAINFIELD IN
46168-2848
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1008
US

V. Phone/Fax

Practice location:
  • Phone: 317-781-7328
  • Fax: 317-781-7216
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02004687A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: