Individual
SAMIR GAMAL ISHAK
Active
Individual
SAMIR GAMAL ISHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
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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