Provider Demographics
NPI:1275696171
Name:KAMRAN, NADEEM U (MD)
Entity Type:Individual
Prefix:
First Name:NADEEM
Middle Name:U
Last Name:KAMRAN
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 1:1007 LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3201
Mailing Address - Country:US
Mailing Address - Phone:219-325-5474
Mailing Address - Fax:219-325-5456
Practice Address - Street 1:1007 LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3201
Practice Address - Country:US
Practice Address - Phone:219-325-5474
Practice Address - Fax:219-325-5456
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048490207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200124170Medicaid
IN000000530569OtherANTHEM,BCBS
IN000000215728OtherPROVIDER BCBS NUMBER
IN110219046OtherRAILROAD PROVIDER NUMBER
IN000000215728OtherPROVIDER BCBS NUMBER
IN170220CMedicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER
IN110219046OtherRAILROAD PROVIDER NUMBER