Provider Demographics
NPI:1265863187
Name:KARIM MOSHREF MD PC
Entity Type:Organization
Organization Name:KARIM MOSHREF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MIR ABDUL KARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHREF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-478-9960
Mailing Address - Street 1:2110 LOWER HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46819-1235
Mailing Address - Country:US
Mailing Address - Phone:260-478-9960
Mailing Address - Fax:260-478-9670
Practice Address - Street 1:2110 LOWER HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46819-1235
Practice Address - Country:US
Practice Address - Phone:260-478-9960
Practice Address - Fax:260-478-9670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042546261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100332850Medicaid