Healthcare Provider Details

I. General information

NPI: 1538329982
Provider Name (Legal Business Name): ISMAIL QATTASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL SQ STE 2200
GREENFIELD IN
46140-1378
US

IV. Provider business mailing address

1 MEMORIAL SQ STE 50
GREENFIELD IN
46140-1357
US

V. Phone/Fax

Practice location:
  • Phone: 317-468-6257
  • Fax: 317-468-6268
Mailing address:
  • Phone: 317-468-6257
  • Fax: 317-468-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036-120417
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01081966A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: