Provider Demographics
NPI:1306011606
Name:AFYOUNI, MOTASEM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOTASEM
Middle Name:
Last Name:AFYOUNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOTASEM
Other - Middle Name:
Other - Last Name:ALAFYOUNI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6309
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46660-6309
Mailing Address - Country:US
Mailing Address - Phone:574-335-8700
Mailing Address - Fax:574-335-0741
Practice Address - Street 1:611 E DOUGLAS
Practice Address - Street 2:SUITE 309
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1467
Practice Address - Country:US
Practice Address - Phone:574-335-6232
Practice Address - Fax:574-335-0776
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065534A207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000219523OtherBCBS IMA
IN000000919573OtherBCBS PLYMOUTH
IN000000711085OtherBCBS
IN000000581807OtherBCBS
IN000000711085OtherBCBS SB
IN200914550Medicaid
ININ1933012Medicare UPIN
IN000000581807OtherBCBS
IN000000919573OtherBCBS PLYMOUTH
INP00674179Medicare PIN
INP01154123Medicare PIN