Provider Demographics
NPI:1376585687
Name:KRAD, MOHAMED MONZER (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:MONZER
Last Name:KRAD
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 1:315 W 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-1003
Mailing Address - Country:US
Mailing Address - Phone:219-923-9200
Mailing Address - Fax:219-972-1557
Practice Address - Street 1:315 W 35TH AVE
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-1003
Practice Address - Country:US
Practice Address - Phone:219-923-9200
Practice Address - Fax:219-972-1557
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1376585687OtherNPI NUMBER
IN100215510Medicaid
IN100215510Medicaid
IN1376585687OtherNPI NUMBER