Individual
MR. ABDOLAZIZ M ARDALAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
9737 DECATUR DR, INDIANAPOLIS, IN 46256-9656
(317) 578-1133
(317) 843-2727
Mailing address
9737 DECATUR DR, INDIANAPOLIS, IN 46256-9656
(317) 578-1133
(317) 537-2862
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
010267201
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000079426
ANTHEM BLUE SHIELD
IN
05
—
100367790A
—
IN
Enumeration date
08/24/2006
Last updated
02/04/2010
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