Individual
HASSAN IMTIAZ AHMAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 448-7634
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
01079818A
IN
207RR0500X
Rheumatology Physician
128401
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300014192
—
IN
01
—
815500568
MEDICARE PTAN
IN
Enumeration date
03/25/2013
Last updated
09/10/2025
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