MEDICARE: IBAD ANSARI 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	174400000X	Specialist	01035152A	IN
2	207RC0000X	Cardiovascular Disease Physician	01035152A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01214593	OTHER	IN	RR MEDICARE PTAN
3	P01215493	OTHER	IN	RR MEDICARE PTAN

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	:	1245219997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBAD ANSARI MD

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 E COUNTY LINE RD
Second Line	:	SUITE 2400
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0963
Country	:	US
Telephone Number	:	317-887-7880
Fax Number	:	317-887-7660

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	06/11/2021

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Directions to “ IBAD ANSARI MD” Practice Location

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