Organization
MERRILLVILLE FAMILY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NADIRA AHMED MD (OWNER)
(219) 769-6363
Entity
Organization
Contact information
Practice address
270 EAST 90TH DRIVE, MERRILLVILLE, IN 46410
(219) 769-6363
(219) 769-3922
Mailing address
270 E 90TH DR, MERRILLVILLE, IN 46410-8102
(219) 769-6363
(219) 769-3922
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01047385A
IN
207Q00000X
Family Medicine Physician
Primary
50004849A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000376214
ANTHEM
IN
05
—
200289300
—
IN
01
—
90001102
BLUE SHIELD OF ILLINOIS
IL
Enumeration date
08/30/2006
Last updated
12/19/2018
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