Provider Demographics
NPI:1962471995
Name:HUSAIN, SALMAN MASEEH (MD)
Entity Type:Individual
Prefix:
First Name:SALMAN
Middle Name:MASEEH
Last Name:HUSAIN
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:253 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1501
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-446-7023
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045312A207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200196040Medicaid
IN10825306OtherCAQH NUMBER
IN000000076434OtherANTHEM UC PROVIDER NUMBE
IN9397174OtherPHCS PID NUMBER
IN000000341037OtherANTHEM FP PROVIDER NUMBER
IN142080LLMedicare PIN
IN921480RMedicare PIN
IN930126878Medicare PIN
IN000000076434OtherANTHEM UC PROVIDER NUMBE
IN10825306OtherCAQH NUMBER
IN815520TMedicare PIN
IN9397174OtherPHCS PID NUMBER
ING77180Medicare UPIN
IN815490BBBMedicare PIN
IN815510LMedicare PIN