Individual
DR. IMAD E. KHADRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3920 ST FRANCIS WAY STE 220, LAFAYETTE, IN 47905
(765) 502-4110
(765) 428-5951
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01036728
IN
207RP1001X
Pulmonary Disease Physician
Primary
01036728
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100087520
—
IN
01
—
M400062471
MEDICARE PTAN
IN
Enumeration date
07/19/2006
Last updated
05/08/2023
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