Provider Demographics
NPI:1003384017
Name:FAMILY FIRST MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:FAMILY FIRST MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAOAA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEN KHADRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-595-0535
Mailing Address - Street 1:8840 CALUMET AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2546
Mailing Address - Country:US
Mailing Address - Phone:219-595-0535
Mailing Address - Fax:
Practice Address - Street 1:8840 CALUMET AVE STE 203
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2546
Practice Address - Country:US
Practice Address - Phone:219-595-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care