MEDICARE: IRENE MORIDI MD

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	207V00000X	Obstetrics & Gynecology Physician	MD-54685	IA
2	207V00000X	Obstetrics & Gynecology Physician	ME161977	FL
3	207V00000X	Obstetrics & Gynecology Physician	T4559	WA
4	207V00000X	Obstetrics & Gynecology Physician	MD210001941	DC
5	207V00000X	Obstetrics & Gynecology Physician	T4559	TX
6	207VX0000X	Obstetrics Physician	MD489965C	PA
7	207V00000X	Obstetrics & Gynecology Physician	13389	WI
8	207V00000X	Obstetrics & Gynecology Physician	C1-0028447	DE
9	207VX0000X	Obstetrics Physician	01096186A	IN

General Provider Information

NPI Number	:	1164955407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE MORIDI MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11725 ILLINOIS ST
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-3008
Country	:	US
Telephone Number	:	317-688-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	06/03/2026

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Directions to “ IRENE MORIDI MD” Practice Location

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