Healthcare Provider Details

I. General information

NPI: 1811661937
Provider Name (Legal Business Name): ASHRAF ASSOUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 SIMPSON AVE
ELKHART IN
46516-4666
US

IV. Provider business mailing address

236 SIMPSON AVE
ELKHART IN
46516-4666
US

V. Phone/Fax

Practice location:
  • Phone: 574-293-0052
  • Fax: 844-560-1543
Mailing address:
  • Phone: 574-293-0052
  • Fax: 844-560-1543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01092087A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: