Provider Demographics
NPI:1750346755
Name:ABONOUR, RAFAT (MD)
Entity type:Individual
Prefix:
First Name:RAFAT
Middle Name:
Last Name:ABONOUR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1044 W WALNUT ST RM 202
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5254
Practice Address - Country:US
Practice Address - Phone:317-274-0843
Practice Address - Fax:317-944-3349
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043602A207R00000X, 207RH0000X
IN01043602207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000109892OtherANTHEM PTAN
IN200028120Medicaid
IN264910I3Medicare PIN