Provider Demographics
NPI:1760463566
Name:KIANI, HOUMAN (MD)
Entity Type:Individual
Prefix:
First Name:HOUMAN
Middle Name:
Last Name:KIANI
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 1:4370 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8223
Mailing Address - Country:US
Mailing Address - Phone:317-405-8044
Mailing Address - Fax:
Practice Address - Street 1:4902 E THOMPSON RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-1905
Practice Address - Country:US
Practice Address - Phone:317-786-1888
Practice Address - Fax:317-786-1889
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042881208D00000X, 207UN0902X
IN01042881A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100047140OtherMEDICARE NUMBER
IN200007060Medicaid
IN200007060Medicaid
ININ2762106Medicare PIN