Provider Demographics
NPI:1073503207
Name:KOJ, IMAD GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:IMAD
Middle Name:GEORGE
Last Name:KOJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 S 7TH ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5710
Mailing Address - Country:US
Mailing Address - Phone:812-235-7370
Mailing Address - Fax:812-235-7570
Practice Address - Street 1:3903 S 7TH ST
Practice Address - Street 2:STE 2E
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-5710
Practice Address - Country:US
Practice Address - Phone:812-235-7370
Practice Address - Fax:812-235-7570
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048808A207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000389741OtherANTHEM PIN
IN200230910Medicaid
INP00283648OtherRAILROAD MEDICARE
IN000000389741OtherANTHEM PIN
INP00283648OtherRAILROAD MEDICARE
IN200230910Medicaid