Individual
NADER REZVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 W 2ND ST, BLOOMINGTON, IN 47403-2317
(866) 483-4804
(317) 870-0499
Mailing address
2312 N DUNN ST, BLOOMINGTON, IN 47408-1327
(866) 483-4804
(317) 870-0499
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01023405
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100182840A
—
IN
Enumeration date
12/18/2006
Last updated
05/13/2016
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