Individual
DR. RAUFU ADEFEMI LASISI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 948-0762
Mailing address
8910 PURDUE RD, STE 500, INDIANAPOLIS, IN 46268-3161
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11013709A
IN
208M00000X
Hospitalist Physician
Primary
01067846A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000672592
HPN ANTHEM PIN#
—
01
—
000000708549
ANTHEM PROVIDER NUMBER / TIN 35-2030653
IN
01
—
200311740H
HPN MEDICAID GROUP#/LOCATION
IN
05
—
200980210
—
IN
01
—
205110
HPN MEDICARE GROUP#
—
Enumeration date
06/02/2008
Last updated
03/04/2014
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