Individual
DR. AHMAD KASSEM EL-SAMAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
9239 BROADWAY, MERRILLVILLE, IN 46410-7046
(219) 736-1010
(219) 736-1090
Mailing address
9120 DOUBLETREE DR S, CROWN POINT, IN 46307-7655
(219) 736-1010
(219) 736-1090
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
07001024A
IN
213EP0504X
Public Medicine Podiatrist
07001024A
IN
213EP1101X
Primary Podiatric Medicine Podiatrist
07001024A
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
07001024A
IN
213ES0131X
Foot Surgery Podiatrist
07001024A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016-005273
MEDICAL LICENSE
IL
01
—
07001024A
MEDICAL LICENSE
IN
01
—
07001024B
INDIANA CSR
IN
05
—
200-824830
—
IN
01
—
6157100001
DMERC
IN
Enumeration date
06/24/2006
Last updated
11/06/2017
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