Provider Demographics
NPI:1952663593
Name:BENKHADRA, RAOAA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAOAA
Middle Name:
Last Name:BENKHADRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAOAA
Other - Middle Name:
Other - Last Name:BEN KHADRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8840 CALUMET AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2546
Mailing Address - Country:US
Mailing Address - Phone:219-595-0535
Mailing Address - Fax:219-595-5319
Practice Address - Street 1:8840 CALUMET AVE STE 203
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2546
Practice Address - Country:US
Practice Address - Phone:219-595-0535
Practice Address - Fax:219-595-5319
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01077720A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300007611Medicaid
IN3087003Medicaid