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1891751079

NPI Code Detail

MEDICARE: MALAZ A BOUSTANI MD

MEDICARE: MALAZ A BOUSTANI 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	01055882A	IN
2	207R00000X	Internal Medicine Physician	01055882A	IN

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
2	000000230417	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1891751079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALAZ A BOUSTANI 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	:	720 ESKENAZI AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5187
Country	:	US
Telephone Number	:	317-880-7666
Fax Number	:

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	12/12/2025

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Directions to “ MALAZ A BOUSTANI MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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