Basic Information
| Provider Information | |||||||||
| NPI: | 1346275666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FATIMA | ||||||||
| FirstName: | SUMAYYA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5150 SHELBYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462372601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177821577 | ||||||||
| FaxNumber: | 8883667577 | ||||||||
| Practice Location | |||||||||
| Address1: | 5150 SHELBYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462372601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177821577 | ||||||||
| FaxNumber: | 8883667577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 09/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD425164 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01061443A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | FA1928165 | 01 | NJ | HIGHMARK BLUE SHIELD - BUCKS/LOWER BUCKS | OTHER | 102291840 0001 | 05 | PA | MEDICAID | 30060503 | 01 | PA | KEYSTONE MERCY-LOWER BUCKS GROUP | OTHER |