Individual
MARYAM MASSOUMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2001 W 86TH ST, 3N MEDICAL EDUCATION, INDIANAPOLIS, IN 46260-1902
(317) 338-2172
Mailing address
10330 N MERIDIAN ST, SUITE 201, INDIANAPOLIS, IN 46290-1024
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01046730A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200160130
—
IN
Enumeration date
12/05/2005
Last updated
08/21/2024
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