MEDICARE: YASIR FASIH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01058432A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00645015	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336142066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASIR FASIH M.D.

Provider Business Mailing Address
First Line	:	505 W LINCOLN HWY
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2650
Country	:	US
Telephone Number	:	219-322-3311
Fax Number	:	219-322-8210

Provider Business Practice Location Address
First Line	:	505 W LINCOLN HWY
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2650
Country	:	US
Telephone Number	:	219-322-3311
Fax Number	:	219-322-8210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2005
Last Update Date	:	06/18/2010

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Directions to “ YASIR FASIH M.D.” Practice Location

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