Provider Demographics
NPI:1710245626
Name:ISMAIL, AUSAMA M (MD)
Entity Type:Individual
Prefix:
First Name:AUSAMA
Middle Name:M
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-890-5500
Mailing Address - Fax:317-890-5566
Practice Address - Street 1:9650 E WASHINGTON ST
Practice Address - Street 2:STE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3032
Practice Address - Country:US
Practice Address - Phone:317-890-5500
Practice Address - Fax:317-890-5566
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2021-01-12
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Provider Licenses
StateLicense IDTaxonomies
IN01075182A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201093890Medicaid
IN068010160Medicare PIN
IN201093890Medicaid