Healthcare Provider Details

I. General information

NPI: 1477841633
Provider Name (Legal Business Name): AHMED ABUSAMRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 E COUNTY LINE RD
INDIANAPOLIS IN
46227-0963
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-7957
  • Fax:
Mailing address:
  • Phone: 317-621-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01072955A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4301099117
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01072955A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: