Provider Demographics
NPI:1164501672
Name:BAROUDI, SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:BAROUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9011 N MERIDIAN ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5378
Mailing Address - Country:US
Mailing Address - Phone:317-574-4747
Mailing Address - Fax:317-574-4737
Practice Address - Street 1:8205 E 56TH ST STE 250
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1097
Practice Address - Country:US
Practice Address - Phone:317-353-8985
Practice Address - Fax:317-353-2389
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004016659207R00000X
IN01067492A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200979110Medicaid
IN796270003Medicare PIN
IN200979110Medicaid