=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700339983
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BURIA NAEEM MBBS, MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2016
-----------------------------------------------------
Last Update Date | 10/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 705 RILEY HOSPITAL DR RM 4900
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46202-5109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-944-7065
-----------------------------------------------------
Fax | 317-944-3442
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 705 RILEY HOSPITAL DR RM 4900
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46202-5109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-944-7065
-----------------------------------------------------
Fax | 317-944-3442
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | BP10056550
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0203X
-----------------------------------------------------
Taxonomy Name | Pediatric Critical Care Medicine Physician
-----------------------------------------------------
License Number | 01082498A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------