Provider Demographics
NPI:1255379673
Name:NEKOOMARAM, MOHAMMAD R (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:R
Last Name:NEKOOMARAM
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 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 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 1:3512 S LAFOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3803
Practice Address - Country:US
Practice Address - Phone:765-865-6633
Practice Address - Fax:765-865-6634
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029903207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01270953OtherRR MEDICARE
IN100327380Medicaid
IN100365080Medicaid
IN200932110AMedicaid
INP01270953OtherRR MEDICARE
ININ1663025Medicare PIN
IN100327380Medicaid
IN356630Medicare PIN
IN259630AMedicare PIN