Individual
MUSTAFA HASSANALI FIDAHUSSEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 W 10TH ST, 4TH FLOOR, INDIANAPOLIS, IN 46202-2859
(317) 630-7979
(317) 630-2668
Mailing address
8910 PURDUE RD, STE 500, INDIANAPOLIS, IN 46268-3161
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0064480
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000693425
ANTHEM
IN
05
—
200999920
—
IN
Enumeration date
08/09/2006
Last updated
07/22/2011
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