Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 07001024A | IN |
N | 222Z00000X | Podiatrist | 07001024A | IN |
N | 213EP0504X | Public Medicine | 07001024A | IN |
N | 213EP1101X | Primary Podiatric Medicine | 07001024A | IN |
Y | 213ES0103X | Foot & Ankle Surgery | 07001024A | IN |
N | 213ES0131X | Foot Surgery | 07001024A | IN |
NPI | 1174559876 |
---|---|
Provider Name | Dr. Ahmad Kassem El-Samad |
First Address | Crown Point, IN 46307-7655 |
Second Address | Merrillville, IN 46410-7046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 06/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016-005273 | MEDICAL LICENSE (01) | IL |
07001024A | MEDICAL LICENSE (01) | IN |
07001024B | INDIANA CSR (01) | IN |
200-824830 | (05) | IN |
6157100001 | DMERC (01) | IN |
V10169 | (02) |