Basic Information
| Provider Information | |||||||||
| NPI: | 1457353781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDEL NOUR | ||||||||
| FirstName: | MAGDY | ||||||||
| MiddleName: | WAGUIH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 N 7TH ST | ||||||||
| Address2: | STE 109 | ||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478071057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122429631 | ||||||||
| FaxNumber: | 8122429647 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 N 7TH ST | ||||||||
| Address2: | STE 109 | ||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478071057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122429631 | ||||||||
| FaxNumber: | 8122429647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 02/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 01059070A | IN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 200384680 | 05 | IN | MEDICAID | 000000331666 | 01 | IN | ANTHEM LPI | OTHER |