Individual
DR. YACOUB MASSUDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
814 LAPORTE AVE, VALPARAISO, IN 46383-5860
(219) 465-4744
Mailing address
105 WILDROSE CT, VALPARAISO, IN 46385-6044
(219) 462-1321
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01024734A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000208898
BC BS IN PROVIDER #
IN
Enumeration date
10/28/2006
Last updated
07/08/2007
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