MEDICARE: AATIF ANSARI

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	122300000X	Dentist	12012330A	IN

General Provider Information

NPI Number	:	1730560087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AATIF ANSARI

Provider Business Mailing Address
First Line	:	8594 E 116TH ST STE 420
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-1611
Country	:	US
Telephone Number	:	715-523-0455
Fax Number	:

Provider Business Practice Location Address
First Line	:	8137 PENDLETON PIKE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-4014
Country	:	US
Telephone Number	:	317-593-2500
Fax Number	:

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

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	06/12/2015

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Directions to “ AATIF ANSARI ” Practice Location

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