Individual
MOAZZAM W HABIB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9240 N MERIDIAN ST, SUITE 240, INDIANAPOLIS, IN 46260-1880
(317) 571-0030
(317) 571-0031
Mailing address
PO BOX 40686, INDIANAPOLIS, IN 46240-0686
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01040236A
IN
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
01040236A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000200129
ANTHEM
IN
05
—
100358590
—
IN
01
—
352135010
TAX ID #
IN
Enumeration date
09/25/2006
Last updated
01/21/2019
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