Individual
ANOUSH JIDARIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1111 RONALD REAGAN PKWY, AVON, IN 46123-7085
(317) 962-3400
(317) 963-5446
Mailing address
1111 RONALD REAGAN PKWY, AVON, IN 46123-7085
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
01075161A
IN
208600000X
Surgery Physician
01075161A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
01075161A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
65129
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003000013A,B
—
GA
01
—
1100207252
ANTHEM PTAN
IN
05
—
201284900
—
IN
01
—
P01549401
MEDICARE RAILROAD PTAN
IN
Enumeration date
07/03/2008
Last updated
03/11/2025
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