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Individual

ABDUL KAWAMLEH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
6375 US HIGHWAY 6 STE B, PORTAGE, IN 46368-5218
(219) 762-0400
(219) 762-2460
Mailing address
6375 US HIGHWAY 6 STE B, PORTAGE, IN 46368-5218
(219) 762-0400
(219) 762-2460

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
10152395A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000180448
ANTHEM BC/BS
IN
05
200279070A
IN
05
200293540A
IN
01
60060435
RAILROAD MEDICARE
IN
01
9115389
ANTHEM BC/BS
IL
Enumeration date
06/01/2005
Last updated
08/24/2011
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