Provider Demographics
NPI:1013115039
Name:SHWAIKI, WASSIM (MD)
Entity type:Individual
Prefix:
First Name:WASSIM
Middle Name:
Last Name:SHWAIKI
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:PO BOX 1103
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-1103
Mailing Address - Country:US
Mailing Address - Phone:219-662-3931
Mailing Address - Fax:219-663-6359
Practice Address - Street 1:8840 CALUMET AVE STE 203
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2546
Practice Address - Country:US
Practice Address - Phone:219-836-7723
Practice Address - Fax:219-836-7726
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064103A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN217960COtherMEDICARE
IN200872190OtherMEDICAID
IL90001173OtherBCBS IL
IN000000527883OtherBCBS IN
P00434655OtherMEDICARE RAILROAD
IN000000527883OtherBCBS IN