Provider Demographics
NPI:1275540361
Name:GHAZALI, MOHAMMED SAAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:SAAD
Last Name:GHAZALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8028 CARNEGIE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5790
Practice Address - Country:US
Practice Address - Phone:260-425-5950
Practice Address - Fax:260-266-5145
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053679A2080P0202X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200318560Medicaid
OH2261574Medicaid
IN163424OtherCHILDRENS SPECIAL HEALTH
IN000000200725OtherBLUE CROSS BLUE SHIELD
IN5440706OtherAETNA INSURANCE