MEDICARE: DIABETES ASSOCIATES OF INDIANA P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063130383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETES ASSOCIATES OF INDIANA P.C.

Provider Business Mailing Address
First Line	:	9526 PARK MERIDIAN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1331
Country	:	US
Telephone Number	:	312-262-6434
Fax Number	:

Provider Business Practice Location Address
First Line	:	9526 PARK MERIDIAN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1331
Country	:	US
Telephone Number	:	317-652-9684
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOAZZAM HABIB
Credential	:	MD
Telephone Number	:	312-262-6434

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	12/03/2025

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