Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01082483A | IN |
NPI | 1003295700 |
---|---|
Provider Name | Ahmed Zia Kiani |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2015 |
Last Update Date | 11/06/2020 |