Provider Demographics
NPI:1982846002
Name:DIALLO, AMADOU DIOGO
Entity Type:Individual
Prefix:MR
First Name:AMADOU
Middle Name:DIOGO
Last Name:DIALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:AMADOU
Other - Middle Name:DIOGO
Other - Last Name:DIALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4623 FALCON GROVE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5919
Mailing Address - Country:US
Mailing Address - Phone:317-513-1077
Mailing Address - Fax:317-704-4249
Practice Address - Street 1:4623 FALCON GROVE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5919
Practice Address - Country:US
Practice Address - Phone:317-513-1077
Practice Address - Fax:317-704-4249
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN870333343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)