Healthcare Provider Details

I. General information

NPI: 1215975354
Provider Name (Legal Business Name): NOVERA INAM INAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 SIM HODGIN PKWY REID HEALTH RESIDENCY CLINIC
RICHMOND IN
47374-1928
US

IV. Provider business mailing address

126 PARKS HALL
ATHENS OH
45701-1359
US

V. Phone/Fax

Practice location:
  • Phone: 765-966-5949
  • Fax: 765-962-6268
Mailing address:
  • Phone: 740-593-4609
  • Fax: 740-593-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.123422
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01061456A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: