Provider Demographics
NPI:1255424743
Name:QUADRI, KAMARTAJ S (MD)
Entity type:Individual
Prefix:MRS
First Name:KAMARTAJ
Middle Name:S
Last Name:QUADRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 PHEASANT CT
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-3385
Mailing Address - Country:US
Mailing Address - Phone:219-793-9214
Mailing Address - Fax:
Practice Address - Street 1:4937 PHEASANT CT
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-3385
Practice Address - Country:US
Practice Address - Phone:219-793-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050515A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5948035OtherAETNA
P00003906OtherRAILROAD MEDICARE
PR20503560001OtherCIGNA HEALTHSOURCE
IN000000294450OtherBLUE CROSS
IN200223180Medicaid
PR20503560001OtherCIGNA HEALTHSOURCE
PR20503560001OtherCIGNA HEALTHSOURCE