Provider Demographics
NPI:1538180757
Name:D'SOUZA, DOUGAL N (MD)
Entity type:Individual
Prefix:
First Name:DOUGAL
Middle Name:N
Last Name:D'SOUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5500 S HOHMAN AVE
Mailing Address - Street 2:SUITE IE
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1965
Mailing Address - Country:US
Mailing Address - Phone:219-937-2187
Mailing Address - Fax:219-937-2195
Practice Address - Street 1:9800 VALPARAISO DR
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4040
Practice Address - Country:US
Practice Address - Phone:219-934-9852
Practice Address - Fax:219-836-7593
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01049977A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200208110Medicaid