Healthcare Provider Details

I. General information

NPI: 1518580059
Provider Name (Legal Business Name): HANI SHAMSEDDEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 18TH ST STE 210
COLUMBUS IN
47201-5362
US

IV. Provider business mailing address

PO BOX 775383
CHICAGO IL
60677-5358
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-8680
  • Fax:
Mailing address:
  • Phone: 812-376-5351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01090408A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: