Provider Demographics
NPI:1285693994
Name:ABDO, TARICK I (DPM)
Entity type:Individual
Prefix:
First Name:TARICK
Middle Name:I
Last Name:ABDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 GEORGETOWN RD STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5794
Mailing Address - Country:US
Mailing Address - Phone:317-297-0661
Mailing Address - Fax:
Practice Address - Street 1:9670 E WASHINGTON ST STE 215
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3051
Practice Address - Country:US
Practice Address - Phone:317-452-8717
Practice Address - Fax:317-897-3295
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000956A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0812540001Medicare NSC
INU96130Medicare UPIN
P00050610Medicare PIN
INCD7693Medicare PIN
521880KMedicare PIN