Provider Demographics
NPI:1598874562
Name:NOROOZI, IRADJ (MD)
Entity Type:Individual
Prefix:
First Name:IRADJ
Middle Name:
Last Name:NOROOZI
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3115
Mailing Address - Fax:812-235-9580
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-242-3115
Practice Address - Fax:812-235-9580
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025229A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000089601OtherANTHEM
IN100249980XMedicaid
160023867OtherRAILROAD MCARE PALAMETTO
IN100249980Medicaid
INP00834950OtherRAILROAD MEDICARE
B29688Medicare UPIN
IN100249980Medicaid
IN859910XMedicare PIN
IN265130A8Medicare PIN