Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 01063092A | IN |
NPI | 1124021829 |
---|---|
Provider Name | Dr. Bassem I Razzouk |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Indianapolis, IN 46260-1902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 11/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00119428 | (05) | MS |
006737242 | (05) | VA |
009913930 | (05) | AL |
0535740 | (05) | IA |
060502401 | (05) | TX |
100017620A | (05) | OK |
1135341 00 | (05) | WY |
1550469 | (05) | LA |
200179550A | (05) | IN |
205028707 | (05) | MO |
3898886 | (05) | TN |
422400000 | (05) | ME |
64928971 | (05) | KY |
7611308 | (05) | NC |
G16455 | (02) | TN |
Q30048 | (05) | SC |