Individual
KAVEH KEVIN TAYEBI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7250 CLEARVISTA DR, STE 355, INDIANAPOLIS, IN 46256-5609
(317) 621-5676
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01072890A
IN
207R00000X
Internal Medicine Physician
MD.34557
AL
208M00000X
Hospitalist Physician
036.133652
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201094340
—
IN
01
—
P01678748
MEDICARE RAILROAD PTAN
IN
Enumeration date
04/12/2010
Last updated
10/14/2016
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