Provider Demographics
NPI:1922014745
Name:FADL, YAZID Y (MD)
Entity Type:Individual
Prefix:
First Name:YAZID
Middle Name:Y
Last Name:FADL
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 SENATE BLVD
Practice Address - Street 2:STE 310
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1196
Practice Address - Country:US
Practice Address - Phone:317-962-2500
Practice Address - Fax:317-962-2515
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062499A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200850440Medicaid
INI64764Medicare UPIN
INM400071971Medicare PIN
INP00388876Medicare PIN
IN183380HHHHMedicare PIN
IN200850440Medicaid
INP00397866Medicare PIN
IN247020BMedicare PIN
INM400039215Medicare PIN