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General NPI Number Information
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NPI Number | 1063130383
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Entity Type | Organization
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Legal Business Name | DIABETES ASSOCIATES OF INDIANA P.C.
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 9526 PARK MERIDIAN DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1331
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Country | US
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Telephone | 317-652-9684
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Fax |
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Provider Business Mailing Address
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Address Line | 9526 PARK MERIDIAN DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1331
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Country | US
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Telephone | 312-262-6434
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOAZZAM HABIB
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Credential | MD
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Telephone | 312-262-6434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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