Provider Demographics
NPI:1154590149
Name:KHARIDI, SUMA (MD)
Entity type:Individual
Prefix:
First Name:SUMA
Middle Name:
Last Name:KHARIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1664 W SMITH VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1550
Practice Address - Country:US
Practice Address - Phone:317-887-7640
Practice Address - Fax:317-887-7664
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066007A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01066007AOtherLICENSE
INP01157051OtherRR MEDICARE PTAN
INM40053845OtherMEDICARE RR
IN827960P6Medicare PIN
IN827950P7Medicare PIN
INM40053845OtherMEDICARE RR
IN142570D4Medicare PIN
IN597680G7Medicare PIN