Provider Demographics
NPI:1881671865
Name:NEPHROLOGY SPECIALISTS, PC.
Entity Type:Organization
Organization Name:NEPHROLOGY SPECIALISTS, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER / TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RAIED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-931-5227
Mailing Address - Street 1:10010 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4055
Mailing Address - Country:US
Mailing Address - Phone:219-924-3450
Mailing Address - Fax:219-924-1640
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:STE 400A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2923
Practice Address - Country:US
Practice Address - Phone:219-931-5227
Practice Address - Fax:219-932-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100212050Medicaid
IN100212050Medicaid