Individual
NIDAL AL-HOSAINAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 676-4660
(812) 676-4501
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
000000
NY
207R00000X
Internal Medicine Physician
01088556A
IN
207RN0300X
Nephrology Physician
Primary
01088556A
IN
207RN0300X
Nephrology Physician
BP10063896
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540869
MEDICARE PTAN
IN
05
—
300075795
—
IN
Enumeration date
07/13/2018
Last updated
09/28/2023
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