Provider Demographics
NPI:1245219997
Name:ANSARI, IBAD (MD)
Entity Type:Individual
Prefix:
First Name:IBAD
Middle Name:
Last Name:ANSARI
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 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1402 E COUNTY LINE RD
Practice Address - Street 2:SUITE 2400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0963
Practice Address - Country:US
Practice Address - Phone:317-887-7880
Practice Address - Fax:317-887-7660
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035152A174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200539450AMedicaid
INP01214593OtherRR MEDICARE PTAN
INP01215493OtherRR MEDICARE PTAN
INP00696346Medicare PIN
INP00289380Medicare PIN
IN200539450AMedicaid
INP01215493OtherRR MEDICARE PTAN
IN266180135Medicare PIN
INE39218Medicare UPIN
IN248520SSMedicare PIN
IN251320NMedicare PIN