Provider Demographics
NPI:1336142066
Name:FASIH, YASIR (MD)
Entity Type:Individual
Prefix:
First Name:YASIR
Middle Name:
Last Name:FASIH
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 1:505 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2650
Mailing Address - Country:US
Mailing Address - Phone:219-322-3311
Mailing Address - Fax:219-322-8210
Practice Address - Street 1:505 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2650
Practice Address - Country:US
Practice Address - Phone:219-322-3311
Practice Address - Fax:219-322-8210
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058432A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200902230AMedicaid
INP00645015OtherRAILROAD MEDICARE
INI13611Medicare UPIN
INP00645015OtherRAILROAD MEDICARE