Organization
TAREK KUDAIMI MD, LLC
Active
Other names
TAREK KUDAIMI MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAREK KUDAIMI MD (OWNER MANAGER)
(219) 836-1310
Entity
Organization
Contact information
Practice address
801 MACARTHUR BLVD, SUITE 305, MUNSTER, IN 46321-2915
(219) 836-1310
(219) 836-0617
Mailing address
801 MACARTHUR BLVD, SUITE 305, MUNSTER, IN 46321-2915
(219) 836-1310
(219) 836-0617
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
01044239
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000095728
ANTHEM
IN
01
—
110182794
RAILROAD MEDICARE
IN
05
—
200191040B
—
IN
01
—
237151
WELLCARE
IN
01
—
3200450
UNITED HEALTH CARE
IN
01
—
90000885
BLUE CROSS BLUE SHIELD ILLINOIS
IL
Enumeration date
01/12/2010
Last updated
01/12/2010
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