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General NPI Number Information
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NPI Number | 1508286667
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Entity Type | Individual
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Provider Name | ANAS SOUQIYYEH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 12750 ST FRANCIS DR
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City | CROWN POINT
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State | IN
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Zip | 46307-0264
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Country | US
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Telephone | 219-757-6121
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Fax | 219-681-6897
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Provider Business Mailing Address
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Address Line | PO BOX 781076
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City | DETROIT
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State | MI
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Zip | 48278-1076
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-1479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301105984
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01085450A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 130589
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 01085450A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 01085450A
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License Number State | IN
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