Provider Demographics
NPI:1538329982
Name:QATTASH, ISMAIL (MD)
Entity Type:Individual
Prefix:
First Name:ISMAIL
Middle Name:
Last Name:QATTASH
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 1:1 MEMORIAL SQ STE 50
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1357
Mailing Address - Country:US
Mailing Address - Phone:317-468-6257
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:1 MEMORIAL SQ STE 2200
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1378
Practice Address - Country:US
Practice Address - Phone:317-468-6257
Practice Address - Fax:317-468-6268
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-120417207RN0300X
IN01081966A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL279500OtherMEDICARE GROUP
IL1538329982 1Medicaid
IL0407950001Medicare NSC
IL1538329982 1Medicaid