Healthcare Provider Details

I. General information

NPI: 1730937384
Provider Name (Legal Business Name): HAMMOUD NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 MEZZANINE DR STE C
LAFAYETTE IN
47905-8635
US

IV. Provider business mailing address

975 MEZZANINE DR STE C
LAFAYETTE IN
47905-8635
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-5220
  • Fax: 765-446-5220
Mailing address:
  • Phone: 765-446-5220
  • Fax: 765-446-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KHALED HAMMOUD
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 765-588-7675