Provider Demographics
NPI:1497756720
Name:ALNAHASS, MAHMOOD GHIYATH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:GHIYATH
Last Name:ALNAHASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:759 45TH ST STE 104
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2939
Practice Address - Country:US
Practice Address - Phone:219-836-3301
Practice Address - Fax:219-836-7523
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2024-01-03
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
IN01055878A2084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200415900AMedicaid
ING64689Medicare UPIN
IN200415900AMedicaid