Provider Demographics
NPI:1487692901
Name:AKISIK, FATIH (MD)
Entity type:Individual
Prefix:DR
First Name:FATIH
Middle Name:
Last Name:AKISIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MUSTAFA
Other - Middle Name:F
Other - Last Name:AKISIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-0860
Mailing Address - Fax:
Practice Address - Street 1:714 N SENATE AVE
Practice Address - Street 2:STE EF100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3763
Practice Address - Country:US
Practice Address - Phone:317-715-6402
Practice Address - Fax:317-715-6415
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051404A207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200395380Medicaid
IN300136798OtherRAILROAD MEDICARE
INH76107Medicare UPIN
IN959090K6Medicare PIN
IN300136798OtherRAILROAD MEDICARE