Provider Demographics
NPI:1689657975
Name:KHALID, ZAFAR U (MD)
Entity Type:Individual
Prefix:
First Name:ZAFAR
Middle Name:U
Last Name:KHALID
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:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-0438
Mailing Address - Country:US
Mailing Address - Phone:219-769-3550
Mailing Address - Fax:219-769-8604
Practice Address - Street 1:8550 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7032
Practice Address - Country:US
Practice Address - Phone:219-769-3550
Practice Address - Fax:219-769-8604
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100191320AMedicaid
257050Medicare PIN
IN100191320AMedicaid