Healthcare Provider Details

I. General information

NPI: 1073554424
Provider Name (Legal Business Name): ISSA SHAMMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 E WASHINGTON ST STE 100
INDIANAPOLIS IN
46229-3032
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-890-5500
  • Fax: 317-890-5566
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01033318
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: