Healthcare Provider Details

I. General information

NPI: 1780024273
Provider Name (Legal Business Name): SAMI ABUQAYYAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HOSPITAL LN STE 303
DANVILLE IN
46122-1998
US

IV. Provider business mailing address

112 HOSPITAL LN STE 303
DANVILLE IN
46122-1998
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-4000
  • Fax: 317-718-4005
Mailing address:
  • Phone: 131-771-8400
  • Fax: 317-718-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01087264A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01087264A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: