Provider Demographics
NPI:1689638033
Name:KUDAIMI, TAREK (MD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:
Last Name:KUDAIMI
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 1:801 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-836-1310
Mailing Address - Fax:219-836-0617
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2915
Practice Address - Country:US
Practice Address - Phone:219-836-1310
Practice Address - Fax:219-836-0617
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044239207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000095728OtherANTHEM
IN110182794OtherRAILROAD MEDICARE
IN200191040BMedicaid
IN3200450OtherUNITED HEALTH CARE
IN5860647OtherAETNA
IL90000885OtherBCBS IL
IN000000095728OtherANTHEM
IL90000885OtherBCBS IL
IN200191040BMedicaid