Provider Demographics
NPI:1861448144
Name:AKISIK, MUALLA (MD)
Entity Type:Individual
Prefix:
First Name:MUALLA
Middle Name:
Last Name:AKISIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9669 E. 146TH STREET
Practice Address - Street 2:SUITE 250
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5004
Practice Address - Country:US
Practice Address - Phone:317-621-3418
Practice Address - Fax:317-621-3415
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01057374A2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01221073OtherRR MEDICARE PTAN
IN200472350Medicaid
IN200472350Medicaid
G31273Medicare UPIN