Individual
BONIFACE NDAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9550 ZIONSVILLE RD, SUITE #200, INDIANAPOLIS, IN 46268-1065
(317) 872-0116
(317) 874-1440
Mailing address
9550 ZIONSVILLE RD, SUITE #200, INDIANAPOLIS, IN 46268-1065
(317) 872-0116
(317) 874-1440
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01056768A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000411290
CARESOURCE
—
05
—
200411290
—
IN
01
—
250832
INDIANA COMPREHENSIVE
IN
01
—
3170605
AETNA
—
01
—
H75615
MERCY HEALTH PLAN
—
Enumeration date
09/07/2006
Last updated
05/06/2022
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