Provider Demographics
NPI:1356311310
Name:KATARIWALA, NASAR (MD)
Entity Type:Individual
Prefix:
First Name:NASAR
Middle Name:
Last Name:KATARIWALA
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 1:130 COMMERCE SQ
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3281
Mailing Address - Country:US
Mailing Address - Phone:219-878-9870
Mailing Address - Fax:219-878-9873
Practice Address - Street 1:130 COMMERCE SQ
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3281
Practice Address - Country:US
Practice Address - Phone:219-878-9870
Practice Address - Fax:219-878-9873
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056291A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200381990Medicaid
217230SMedicare PIN
IN200381990Medicaid