Basic Information
| Provider Information | |||||||||
| NPI: | 1275552481 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKDASH | ||||||||
| FirstName: | WAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652985706 | ||||||||
| FaxNumber: | 7652985279 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 MEDICAL ARTS BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652985280 | ||||||||
| FaxNumber: | 7652985279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 09/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01047723 | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01047723A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | DB6584 | 01 | IN | RR MEDICARE | OTHER | 200160960 | 05 | IN | MEDICAID | P00120305 | 01 | IN | RR MEDICARE | OTHER | 200325490N | 05 | IN | MEDICAID | P01014114 | 01 | IN | RR MEDICARE PTAN | OTHER | 000000313050 | 01 | IN | ANTHEM | OTHER |