Provider Demographics
NPI:1093770745
Name:GUIRGUIS, ABDELMESSIAH K (MD)
Entity Type:Individual
Prefix:
First Name:ABDELMESSIAH
Middle Name:K
Last Name:GUIRGUIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:GUIRGUIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3395
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1373 E SR 62
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250
Practice Address - Country:US
Practice Address - Phone:812-801-0826
Practice Address - Fax:812-801-0762
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065798A207R00000X
KY38633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200113390Medicaid
IN7307592OtherAETNA
IN412840UUUOtherMEDICARE
KY50024161OtherKY PASSPORT
IN580465OtherANTHEM
KY64087984Medicaid