Basic Information
| Provider Information | |||||||||
| NPI: | 1376512087 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAIDER | ||||||||
| FirstName: | FYEZA | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7001 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462077001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178023109 | ||||||||
| FaxNumber: | 3178700499 | ||||||||
| Practice Location | |||||||||
| Address1: | 8424 NAAB RD | ||||||||
| Address2: | STE 3J | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462605918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178727396 | ||||||||
| FaxNumber: | 3178798328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 10/24/2016 | ||||||||
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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 | MD426925 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 01070937A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 201084760 | 05 | IN | MEDICAID | 01070937A | 01 | IN | LICENSE | OTHER |