MEDICARE: DR. BASMAN ABDEL SALOUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01043104A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000085201	OTHER	IN	BCBS BMG MAIN STREET
2	000000085202	OTHER	IN	BCBS BMG IRELAND RD MED POINT
3	000000195021	OTHER	IN	BCBS BMG E BLAIR WARNER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000314664	OTHER	IN	BCBS BMG IRELAND RD
6	000000111141	OTHER	IN	BCBS BMG PORTAGE RD

General Provider Information

NPI Number	:	1982687521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASMAN ABDEL SALOUS M.D.

Provider Business Mailing Address
First Line	:	710 N NILES AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-1924
Country	:	US
Telephone Number	:	574-647-1610
Fax Number	:

Provider Business Practice Location Address
First Line	:	6913 N MAIN ST STE 300
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-8039
Country	:	US
Telephone Number	:	574-647-1500
Fax Number	:	574-243-4310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	05/01/2023

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