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Individual

SAMIR GAMAL ISHAK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
500 W VOTAW ST, PORTLAND, IN 47371-1322
(260) 418-7036
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01050654A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000644855
ANTHEM
IN
05
200490520
IN
05
200490520A
IN
Enumeration date
10/05/2005
Last updated
02/03/2021
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