Provider Demographics
NPI:1770797466
Name:ELBASH, AHMAD FERAS (MD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:FERAS
Last Name:ELBASH
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 1:1100 REID PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-962-1337
Mailing Address - Fax:765-966-0858
Practice Address - Street 1:1100 REID PKWY STE 210
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-962-1337
Practice Address - Fax:765-966-0858
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.122482207RI0011X
IN01070618A207RI0011X, 207RI0011X
WV22046207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201073080OtherMEDICAID (EKG GROUP)
IN201073080Medicaid
OH2759644Medicaid
IN000000772771OtherANTHEM BCBS
000000773159OtherANTHEM (EKG GROUP)
INM400074895OtherMEDICARE (REID EKG GROUP)
INM400074895OtherMEDICARE (REID EKG GROUP)
000000773159OtherANTHEM (EKG GROUP)
INM400074895OtherMEDICARE (REID EKG GROUP)