Individual
WASIM A KHASAWNEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
(765) 488-8564
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01075923A
IN
208000000X
Pediatrics Physician
35.098001
OH
208000000X
Pediatrics Physician
57012659
OH
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
01075923A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000964894
ANTHEM PROVIDER NUMBER
IN
05
—
201320950
—
IN
Enumeration date
10/04/2007
Last updated
07/21/2022
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