Provider Demographics
NPI:1710905666
Name:ABEDALLHADI, SUBRIE AHMED (MD)
Entity Type:Individual
Prefix:
First Name:SUBRIE
Middle Name:AHMED
Last Name:ABEDALLHADI
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 1:1210 MEDICAL ARTS BLVD # A
Practice Address - Street 2:SUITE 105
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3461
Practice Address - Country:US
Practice Address - Phone:765-298-4660
Practice Address - Fax:765-298-4926
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062234A174400000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200856590Medicaid
INP01214598OtherRR MEDICARE PTAN
INBA8453766OtherDEA #
IN200856590Medicaid
INM400018572Medicare PIN
IN677700SMedicare PIN
INI02572Medicare UPIN
IN266180142Medicare PIN