Provider Demographics
NPI:1710909866
Name:FAZLANI, NAVEED A (MD, MBA)
Entity Type:Individual
Prefix:MR
First Name:NAVEED
Middle Name:A
Last Name:FAZLANI
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1348
Mailing Address - Country:US
Mailing Address - Phone:208-488-1801
Mailing Address - Fax:812-663-5932
Practice Address - Street 1:718 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1348
Practice Address - Country:US
Practice Address - Phone:812-662-0588
Practice Address - Fax:812-663-5932
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068878207R00000X
IDM-13123207R00000X
IN01043529A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201329930Medicaid
IN940420031Medicare PIN
OHG41393Medicare UPIN
OHFA0835134Medicare ID - Type Unspecified
FA0835138Medicare PIN