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
State | License ID | Taxonomies |
---|---|---|
IN | 01064103A | 207RP1001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 217960C | Other | MEDICARE |
IN | 200872190 | Other | MEDICAID |
IL | 90001173 | Other | BCBS IL |
IN | 000000527883 | Other | BCBS IN |
P00434655 | Other | MEDICARE RAILROAD | |
IN | 000000527883 | Other | BCBS IN |