MEDICARE: INDIANA PHYSICIAN SPECIALISTS LLC

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	261QP3300X	Pain Clinic/Center
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1366238669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA PHYSICIAN SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	811 S CENTRAL EXPY STE 103
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-7439
Country	:	US
Telephone Number	:	972-636-5727
Fax Number	:

Provider Business Practice Location Address
First Line	:	3847 EUCLID AVE
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-2332
Country	:	US
Telephone Number	:	219-285-8224
Fax Number	:	219-285-8228

Authorized Official
Title or Position	:	OWNER
Name	:	SYED KAZMI
Credential	:	MD
Telephone Number	:	219-285-8224

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/15/2025

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