=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780024273
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMI ABUQAYYAS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2013
-----------------------------------------------------
Last Update Date | 03/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 HOSPITAL LN STE 303
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46122-1998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-718-4000
-----------------------------------------------------
Fax | 317-718-4005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 HOSPITAL LN STE 303
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46122-1998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 131-771-8400
-----------------------------------------------------
Fax | 317-718-4005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 01087264A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 01087264A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------