Provider Demographics
NPI:1093920258
Name:SALAHUDDIN, AZRA KHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AZRA
Middle Name:KHAN
Last Name:SALAHUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AZRA
Other - Middle Name:BEGUM
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1481 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2803
Mailing Address - Country:US
Mailing Address - Phone:317-988-2492
Mailing Address - Fax:317-988-3159
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2492
Practice Address - Fax:317-988-3159
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA398662081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine