MEDICARE: INDIANA CENTER FOR HEALTH AND NUTRITION

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	261QM2500X	Medical Specialty Clinic/Center	01025488A	IN

General Provider Information

NPI Number	:	1881875540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA CENTER FOR HEALTH AND NUTRITION

Provider Business Mailing Address
First Line	:	7440 N SHADELAND AVE
Second Line	:	SUITE 206
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7440 N SHADELAND AVE
Second Line	:	SUITE 206
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2029
Country	:	US
Telephone Number	:	317-577-5590
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RASHID KHAIRI
Credential	:
Telephone Number	:	317-577-5590

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	01/08/2008

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