MEDICARE: ARIA ARRIZABALAGA 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	M9109	ID
2	207Q00000X	Family Medicine Physician	MD00046851	WA
3	207Q00000X	Family Medicine Physician	01071400A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01157034	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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912971029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIA ARRIZABALAGA 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	:	10122 E. 10TH STREET
Second Line	:	SUITE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-2697
Country	:	US
Telephone Number	:	317-355-5717
Fax Number	:	317-355-3760

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	02/26/2024

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Directions to “ ARIA ARRIZABALAGA MD” Practice Location

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