Healthcare Provider Details

I. General information

NPI: 1427162288
Provider Name (Legal Business Name): OSAMA G. AYAD MD, FACP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E 84TH DR STE 200
MERRILLVILLE IN
46410-6643
US

IV. Provider business mailing address

370 E 84TH DR STE 200
MERRILLVILLE IN
46410-6643
US

V. Phone/Fax

Practice location:
  • Phone: 121-983-6109
  • Fax: 219-836-1786
Mailing address:
  • Phone: 219-836-1096
  • Fax: 219-836-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number01066512A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01066512A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: