Individual
TAREQ BRAIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
85 E US HIGHWAY 6 STE 200, VALPARAISO, IN 46383-8947
(219) 983-6260
(219) 983-6060
Mailing address
2022 KELLE DR, CHESTERTON, IN 46304-8708
(219) 364-3616
(219) 364-3610
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
01077904A
IN
207RH0003X
Hematology & Oncology Physician
MD2011-0742
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932187044
GROUP NPI
NM
01
—
800521089
GROUP MCR
NM
05
—
83221328
—
NM
01
—
P01121737
MEDICARE RAILROAD CARRIER
NM
01
—
Z2565
GROUP MCD
NM
Enumeration date
09/15/2010
Last updated
09/10/2020
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