Healthcare Provider Details

I. General information

NPI: 1033055728
Provider Name (Legal Business Name): ALA SHIYAB MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N WABASH AVE STE 370
MARION IN
46952-2678
US

IV. Provider business mailing address

330 N WABASH AVE STE 370
MARION IN
46952-2678
US

V. Phone/Fax

Practice location:
  • Phone: 765-416-3166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ALA SHIYAB
Title or Position: OWNER
Credential: MD
Phone: 765-416-3166