Individual
MOHAMMAD TAVASSOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
4902 E THOMPSON RD, INDIANAPOLIS, IN 46237-1905
(317) 786-1888
(317) 786-1889
Mailing address
3230 RUE CHANEL APT 158, INDIANAPOLIS, IN 46227-6669
(317) 717-1894
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02002291A
IN
Other
Enumeration date
03/16/2007
Last updated
07/08/2007
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