Individual
SHAGHAYEGH KHAYAMBASHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
541 CLINICAL DR RM CL370, INDIANAPOLIS, IN 46202-5233
(317) 274-7177
(317) 274-7792
Mailing address
541 CLINICAL DR RM CL370, INDIANAPOLIS, IN 46202-5233
(317) 274-7177
(317) 274-7792
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R72516
AZ
390200000X
Student in an Organized Health Care Education/Training Program
Primary
11017774A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11017774A
MEDICAL RESIDENCY PERMIT
IN
01
—
R72516
TRAINING PERMIT
AZ
Enumeration date
08/24/2011
Last updated
06/14/2014
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