Provider Demographics
NPI:1720038680
Name:ASFOUR, WAIL E (MD)
Entity Type:Individual
Prefix:DR
First Name:WAIL
Middle Name:E
Last Name:ASFOUR
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 1:10010 DONALD POWERS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-934-4200
Mailing Address - Fax:219-934-6240
Practice Address - Street 1:10010 DONALD POWERS DRIVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-934-4200
Practice Address - Fax:219-934-6240
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053031A207RC0000X
IL036-103455207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200403430AMedicaid
ING63669Medicare UPIN
IN707050FFMedicare PIN