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General NPI Number Information
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NPI Number | 1154600492
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Entity Type | Individual
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Provider Name | TARIQ HUSSNI ALI ENEZATE MD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 2325 18TH ST STE 130
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City | COLUMBUS
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State | IN
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Zip | 47201-5387
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Country | US
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Telephone | 812-379-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 775383
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City | CHICAGO
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State | IL
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Zip | 60677-5383
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Country | US
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Telephone | 812-376-5315
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2017-02439
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 01098160A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036157953
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2017-02439
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2014027804
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License Number State | MO
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Taxonomy #6
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 2017-02439
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License Number State | NC
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036157953
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License Number State | IL
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Taxonomy #8
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 036157953
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License Number State | IL
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Taxonomy #9
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2014027804
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License Number State | MO
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