Healthcare Provider Details

I. General information

NPI: 1417188491
Provider Name (Legal Business Name): ANAS ALZUHAILI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 E 10TH ST
JEFFERSONVILLE IN
47130-6016
US

IV. Provider business mailing address

2100 MARKET ST STE 101
CHARLESTOWN IN
47111-9535
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-2488
  • Fax: 770-573-9513
Mailing address:
  • Phone: 812-503-5100
  • Fax: 770-573-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01070876A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD446903
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD446903
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.129017
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01070876A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.129017
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: