Provider Demographics
NPI:1629011747
Name:KUDAIMI, MUHAMMAD M (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:M
Last Name:KUDAIMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:STE 303
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2920
Mailing Address - Country:US
Mailing Address - Phone:219-836-4077
Mailing Address - Fax:219-836-1127
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:STE 303
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2920
Practice Address - Country:US
Practice Address - Phone:219-836-4077
Practice Address - Fax:219-839-1127
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01036331A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062243OtherMEDICAID IL
IN010021034OtherMEDICARE RAILROAD
IN000000095538OtherANTHEM
IN100215010AMedicaid
IL90000937OtherBLUE CROSS BLUE SHIELD
7285621004OtherCIGNA
IN100215010AMedicaid
IL036062243OtherMEDICAID IL