Provider Demographics
NPI:1184733008
Name:KAAKAJI, WAYEL (MD)
Entity type:Individual
Prefix:DR
First Name:WAYEL
Middle Name:
Last Name:KAAKAJI
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 1:801 MACARTHUR BLVD
Mailing Address - Street 2:STE 405
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2919
Mailing Address - Country:US
Mailing Address - Phone:219-836-5167
Mailing Address - Fax:219-836-5249
Practice Address - Street 1:801 MACARTHUR BLVD
Practice Address - Street 2:STE 405
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2919
Practice Address - Country:US
Practice Address - Phone:219-836-5167
Practice Address - Fax:219-836-5249
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050352A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200136330AMedicaid
IN5474730021Medicare PIN
IN200136330AMedicaid
IN220030Medicare ID - Type Unspecified
INH02639Medicare UPIN