Provider Demographics
NPI:1043409758
Name:KAMEL INC.
Entity Type:Organization
Organization Name:KAMEL INC.
Other - Org Name:ERIC J. HEATHERS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:765-864-5704
Mailing Address - Street 1:3508 S LAFOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3803
Mailing Address - Country:US
Mailing Address - Phone:765-864-5704
Mailing Address - Fax:765-864-5720
Practice Address - Street 1:3508 S LAFOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3803
Practice Address - Country:US
Practice Address - Phone:765-864-5704
Practice Address - Fax:765-864-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044350A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN217900Medicare PIN