| Healthy Aging Enterprise, LLC | |
|
10926 Belle Plaine Blvd Fishers IN 46037-7113 | |
| (317) 985-9501 | |
| Not Available |
| Full Name | Healthy Aging Enterprise, LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 10926 Belle Plaine Blvd, Fishers, Indiana |
| Authorized Official Name and Position | Marwan Mustaklem (MBR) |
| Authorized Official Contact | 3179859501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthy Aging Enterprise, LLC 10926 Belle Plaine Blvd Fishers IN 46037-7113 | Healthy Aging Enterprise, LLC 10926 Belle Plaine Blvd Fishers IN 46037-7113 Ph: (317) 985-9501 |
| NPI Number | 1417315102 |
|---|---|
| Provider Enumeration Date | 02/09/2016 |
| Last Update Date | 02/09/2016 |
| Medicare PECOS PAC ID | 2668778010 |
|---|---|
| Medicare Enrollment ID | O20160310000836 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417315102 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Marwan Mustaklem |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750357513 PECOS PAC ID: 0941102644 Enrollment ID: I20070327000115 |
| Provider Name | Rona a Abu Manneh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548432511 PECOS PAC ID: 4082884341 Enrollment ID: I20110825000019 |
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