Individual
RONALD MASTOURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1801 N SENATE AVE, MPC II STE. 4000, INDIANAPOLIS, IN 46202
(317) 962-0095
(317) 962-0113
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01067326A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11012317A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109684
ANTHEM PTAN
IN
01
—
000000663387
ANTHEM PTAN
IN
01
—
000001132526
ANTHEM PTAN
IN
05
—
200982540
—
IN
01
—
P00910464
RAILROAD MEDICARE
IN
Enumeration date
06/16/2008
Last updated
03/14/2025
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