Provider Demographics
NPI:1356343578
Name:SHUGHOURY, AHMAD BASSEL (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:BASSEL
Last Name:SHUGHOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:8895 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7037
Practice Address - Country:US
Practice Address - Phone:219-738-2081
Practice Address - Fax:219-736-4658
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059363A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9115389OtherANTHEM BC/BS
IN200108230AMedicaid
INP00204531OtherRAILROAD MEDICARE
IN000000346359OtherANTHEM BC/BS
G15661Medicare UPIN
IN000000346359OtherANTHEM BC/BS