Provider Demographics
NPI:1033113550
Name:TUSHAN, FAYEZ S (MD)
Entity Type:Individual
Prefix:
First Name:FAYEZ
Middle Name:S
Last Name:TUSHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N SHADELAND AVE
Mailing Address - Street 2:SUITE G1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4817
Mailing Address - Country:US
Mailing Address - Phone:317-355-9783
Mailing Address - Fax:317-355-9760
Practice Address - Street 1:7250 CLEARVISTA DR
Practice Address - Street 2:SUITE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4640
Practice Address - Country:US
Practice Address - Phone:317-621-5676
Practice Address - Fax:317-621-5678
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023737A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100318520AMedicaid
IND95342Medicare UPIN
IN251320VVMedicare PIN
IN675230IMedicare ID - Type Unspecified