Healthcare Provider Details

I. General information

NPI: 1336133289
Provider Name (Legal Business Name): AHSAN IMRAN USMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HIGHLAND RD STE 1
RICHMOND IN
47374-8810
US

IV. Provider business mailing address

1100 REID PARKWAY MEDICAL STAFF SERVICES
RICHMOND IN
47374
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-8866
  • Fax: 765-935-8865
Mailing address:
  • Phone: 765-935-8802
  • Fax: 765-983-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35.087875
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35.087875
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01068862A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: