Individual
DANIEL NISI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 948-7569
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
57.028729
OH
2085R0202X
Diagnostic Radiology Physician
01087834A
IN
2085R0202X
Diagnostic Radiology Physician
11019445A
IN
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01087834A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001660024
ANTHEM PTAN
IN
05
—
300003169
—
IN
01
—
Q00439517
RAILROAD PTAN
IN
Enumeration date
05/31/2016
Last updated
10/29/2024
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