Provider Demographics
NPI:1184625774
Name:ELASSAL, SHERIF M (MD)
Entity type:Individual
Prefix:
First Name:SHERIF
Middle Name:M
Last Name:ELASSAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9011 N MERIDIAN ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5378
Mailing Address - Country:US
Mailing Address - Phone:317-574-4747
Mailing Address - Fax:317-574-4737
Practice Address - Street 1:960 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-2317
Practice Address - Country:US
Practice Address - Phone:765-962-4735
Practice Address - Fax:765-939-0035
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2017-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01052996207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200355980Medicaid
IN390008142Medicare PIN
IN796270EEMedicare PIN
IN224510AMedicare PIN
ING66522Medicare UPIN