Basic Information
| Provider Information | |||||||||
| NPI: | 1679709216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAQVI | ||||||||
| FirstName: | SYEDA | ||||||||
| MiddleName: | SADAF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502805 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 N. RITTER AVENUE | ||||||||
| Address2: | SUITE 231 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176214657 | ||||||||
| FaxNumber: | 3173558750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01070403A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | KY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207QG0300X | 01070403A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01291598 | 01 | IN | MEDICARE RR PTAN | OTHER | 201085150 | 05 | IN | MEDICAID |