Provider Demographics
NPI:1710163837
Name:AL-KHARRAT, MOHAMMAD SAMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:SAMIR
Last Name:AL-KHARRAT
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 1:17648 MORSE ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1420
Mailing Address - Country:US
Mailing Address - Phone:219-696-6258
Mailing Address - Fax:219-696-6292
Practice Address - Street 1:17648 MORSE ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1420
Practice Address - Country:US
Practice Address - Phone:219-696-6258
Practice Address - Fax:219-696-6292
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068856A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400065212Medicare PIN
019341D61Medicare PIN