Provider Demographics
NPI:1568496800
Name:GHATTAS, SOHEIR E (MD)
Entity Type:Individual
Prefix:
First Name:SOHEIR
Middle Name:E
Last Name:GHATTAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SOHEIR
Other - Middle Name:E
Other - Last Name:DAWLATLY-GHATTAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8177 CLEARVISTA PKWY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1662
Practice Address - Country:US
Practice Address - Phone:317-621-7801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044623A207P00000X
IN01044623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200117780Medicaid
IN01044623AOtherINDIANA LICENSE
IN01044623BOtherCSR
IN01044623BOtherCSR
IN01044623AOtherINDIANA LICENSE
IN266180016Medicare PIN
IN01044623BOtherCSR