Provider Demographics
NPI:1659361483
Name:QAZI, RAHILA I (MD)
Entity Type:Individual
Prefix:
First Name:RAHILA
Middle Name:I
Last Name:QAZI
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 1:240 N TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3988
Mailing Address - Country:US
Mailing Address - Phone:765-288-1928
Mailing Address - Fax:765-741-0335
Practice Address - Street 1:2506 WILLOWBROOK PKWY STE 102
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1542
Practice Address - Country:US
Practice Address - Phone:317-803-2270
Practice Address - Fax:317-217-1769
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049751A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000524834OtherANTHEM BLUE CROSS BLUE SHIELD
IN200263520Medicaid
344840VVVVMedicare PIN
000000524834OtherANTHEM BLUE CROSS BLUE SHIELD
IN210780JJMedicare ID - Type Unspecified