Individual
DR. ANDRES FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1801 N SENATE BLVD, MPC2 SUITE 3500, INDIANAPOLIS, IN 46202-1228
(317) 962-0280
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
01065981A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200980740
—
IN
01
—
815500263
MEDICARE PTAN
IN
01
—
M400018709
MEDICARE PTAN
IN
01
—
P00911441
RAILROAD PTAN
IN
Enumeration date
05/22/2008
Last updated
08/09/2023
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