Provider Demographics
NPI:1376512087
Name:HAIDER, FYEZA S (MD)
Entity Type:Individual
Prefix:DR
First Name:FYEZA
Middle Name:S
Last Name:HAIDER
Suffix:
Gender:F
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:PO BOX 7001
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46207-7001
Mailing Address - Country:US
Mailing Address - Phone:317-802-3109
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:8424 NAAB RD
Practice Address - Street 2:STE 3J
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5918
Practice Address - Country:US
Practice Address - Phone:317-872-7396
Practice Address - Fax:317-879-8328
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426925207R00000X
IN01070937A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201084760Medicaid
IN01070937AOtherLICENSE
IN249510001Medicare PIN
IN01070937AOtherLICENSE