Provider Demographics
NPI:1275552481
Name:BAKDASH, WAEL (MD)
Entity Type:Individual
Prefix:
First Name:WAEL
Middle Name:
Last Name:BAKDASH
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:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:765-298-5706
Mailing Address - Fax:765-298-5279
Practice Address - Street 1:1601 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3458
Practice Address - Country:US
Practice Address - Phone:765-298-5280
Practice Address - Fax:765-298-5279
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047723207R00000X
IN01047723A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDB6584OtherRR MEDICARE
IN200160960Medicaid
INP00120305OtherRR MEDICARE
IN200325490NMedicaid
INP01014114OtherRR MEDICARE PTAN
IN000000313050OtherANTHEM
INP01014114OtherRR MEDICARE PTAN
IN215110AMedicare PIN
IN200160960Medicaid
IN208790001Medicare PIN