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Individual

AHMAD FATHI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
9130 COLUMBIA AVE, SUITE A, MUNSTER, IN 46321
(219) 836-4343
(219) 836-4387
Mailing address
9130 COLUMBIA AVE, SUITE A, MUNSTER, IN 46321
(219) 836-4343
(219) 836-4387

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01029379A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000280509
BCBS
IN
01
90001113
BCBS
IL
Enumeration date
02/02/2007
Last updated
07/08/2007
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