Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 01064103A | IN |
NPI | 1013115039 |
---|---|
Provider Name | Wassim Shwaiki |
First Address | Crown Point, IN 46308-1103 |
Second Address | Munster, IN 46321-2546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000527883 | BCBS IN (01) | IN |
200872190 | MEDICAID (01) | IN |
217960C | MEDICARE (01) | IN |
90001173 | BCBS IL (01) | IL |
P00434655 | MEDICARE RAILROAD (01) |