Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 01079145A | IN |
N | 208200000X | Surgeon | 01079145A | IN |
N | 208600000X | Surgeon | 01079145A | IN |
N | 208200000X | Surgeon | 57.020814 | OH |
N | 208600000X | Surgeon | 57.020814 | OH |
N | 208200000X | Surgeon | MTL003109 | DC |
N | 208600000X | Surgeon | MTL003109 | DC |
NPI | 1114271483 |
---|---|
Provider Name | Ahmed Mohammed Ibrahim Elsabbagh |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Indianapolis, IN 46260-1972 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2012 |
Last Update Date | 28/11/2017 |