Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01052558 | IN |
N | 111NI0900X | Internist | 01052558 | IN |
Y | 207RN0300X | Nephrologist | 01052588A | IN |
NPI | 1063417657 |
---|---|
Provider Name | Raied Abdullah |
First Address | Munster, IN 46321-2915 |
Second Address | Gary, IN 46409-1036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 14/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200264560 | (05) | IN |
G54273 | (02) |