Shakoora Aneesah Al-Khattab, MD, PHD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Indianapolis, IN
NPI 1841995479 · NPPES record last updated Nov 20, 2024
Key facts
- NPI
- 1841995479
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 705 Riley Hospital Dr RM 5837
Indianapolis, IN 46202-5109 - Phone
- (317) 948-0003
- NPI assigned
- Apr 3, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230518000588 | IN | Order and Referring Only - Internal Medicine |
6608232541 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine, Doctor of Philosophy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
705 Riley Hospital Dr RM 5837
Indianapolis, IN 46202-5109
Mailing address
705 Riley Hospital Dr RM 5837
Indianapolis, IN 46202-5109
Phone (317) 948-0003
Other providers in Indianapolis, IN
- Ahmad A Al-Hader
- Mohammed Abdulkareem Al-Hamed
- Karam Al-Issa
- Zeina Al-Khalil
- Halima Al-Khattab
- Ahmad Al-Najjar
- Mayyadah Al-Nuaimi
- Ahmed Khalid Al-Omari
- Omar Al-Saraireh
- Mariam Al-Thaaqib
All providers in Indianapolis, IN · Student in an Organized Health Care Education/Training Program in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.