Provider Demographics
NPI:1982687521
Name:SALOUS, BASMAN ABDEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BASMAN
Middle Name:ABDEL
Last Name:SALOUS
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 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:6913 N MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8039
Practice Address - Country:US
Practice Address - Phone:574-647-1500
Practice Address - Fax:574-243-4310
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043104A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000085201OtherBCBS BMG MAIN STREET
IN000000085202OtherBCBS BMG IRELAND RD MED POINT
IN000000195021OtherBCBS BMG E BLAIR WARNER
IN200042370Medicaid
IN000000314664OtherBCBS BMG IRELAND RD
IN000000111141OtherBCBS BMG PORTAGE RD
IN000000195021OtherBCBS BMG E BLAIR WARNER
IN000000314664OtherBCBS BMG IRELAND RD
IN162520HHMedicare PIN
IN000000195021OtherBCBS BMG E BLAIR WARNER
INF96767Medicare UPIN