Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01072153A | IN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 01072153A | IN |
NPI | 1114151669 |
---|---|
Provider Name | Ehab Wanas |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Greenwood, IN 46143-1072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2009 |
Last Update Date | 13/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201164970 | (05) | IN |