Individual
HISHAM S ELHASSAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 320, FORT WAYNE, IN 46845-1733
(260) 266-5300
(260) 266-5314
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
01063769A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000595627
ANTHEM
IN
01
—
000000614689
ANTHEM
IN
05
—
200871160
—
IN
01
—
P00664356
MEDICARE RAILROAD
IN
Enumeration date
04/10/2007
Last updated
10/17/2022
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