Provider Demographics
NPI:1689834699
Name:MUHAMMAD M. KUDAIMI
Entity Type:Organization
Organization Name:MUHAMMAD M. KUDAIMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUDAIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-662-3931
Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-662-3931
Mailing Address - Fax:219-661-9906
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2915
Practice Address - Country:US
Practice Address - Phone:219-662-3931
Practice Address - Fax:219-661-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036331A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000095538OtherBCBS IN
IL90000937OtherBCBS IL
IN10021034OtherMEDICARE RAILROAD
IL036062243OtherMEDICAID IL
7285621004OtherCIGNA
IN100215010AMedicaid
7285621004OtherCIGNA
IN000000095538OtherBCBS IN