Healthcare Provider Details

I. General information

NPI: 1588865075
Provider Name (Legal Business Name): AHMAD AL-SHOHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 S 4TH ST
TERRE HAUTE IN
47802-5540
US

IV. Provider business mailing address

3560 S 4TH ST
TERRE HAUTE IN
47802-5540
US

V. Phone/Fax

Practice location:
  • Phone: 812-235-8496
  • Fax: 812-478-1540
Mailing address:
  • Phone: 812-235-8496
  • Fax: 812-478-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35.092840
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: