Provider Demographics
NPI:1487115341
Name:BERAN, AZIZULLAH AHMADALLAH (MD)
Entity type:Individual
Prefix:
First Name:AZIZULLAH
Middle Name:AHMADALLAH
Last Name:BERAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 ROTARY CIR STE 225
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5133
Mailing Address - Country:US
Mailing Address - Phone:317-278-4427
Mailing Address - Fax:567-420-1630
Practice Address - Street 1:702 ROTARY CIR STE 225
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5133
Practice Address - Country:US
Practice Address - Phone:317-278-4427
Practice Address - Fax:567-420-1630
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01087561A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program