Organization
AGAM ENTERPRISES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AYMAN GHONIEM MD (OWNER)
(812) 234-8261
Entity
Organization
Contact information
Practice address
938 SPRINGDALE LN, TERRE HAUTE, IN 47802-4586
(812) 234-8261
(812) 234-8262
Mailing address
PO BOX 2064, INDIANAPOLIS, IN 46206-2064
(812) 234-8261
(812) 234-8262
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01056877A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200882990A
—
IN
Enumeration date
04/18/2008
Last updated
07/15/2008
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