Provider Demographics
NPI:1306848577
Name:KAWAMLEH, ABDUL (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:KAWAMLEH
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 1:6375 US HIGHWAY 6 STE B
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5218
Mailing Address - Country:US
Mailing Address - Phone:219-762-0400
Mailing Address - Fax:219-762-2460
Practice Address - Street 1:6375 US HIGHWAY 6 STE B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5218
Practice Address - Country:US
Practice Address - Phone:219-762-0400
Practice Address - Fax:219-762-2460
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10152395A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200293540AMedicaid
IL9115389OtherANTHEM BC/BS
IN60060435OtherRAILROAD MEDICARE
IN000000180448OtherANTHEM BC/BS
IN200279070AMedicaid
IN60060435OtherRAILROAD MEDICARE
IN200293540AMedicaid
160150Medicare PIN
IN256970CMedicare PIN
221020LMedicare PIN
IN060060226Medicare PIN
IL9115389OtherANTHEM BC/BS