Provider Demographics
NPI:1265658991
Name:VEIN CENTER OF NORTHWEST INDIANA
Entity type:Organization
Organization Name:VEIN CENTER OF NORTHWEST INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-736-8118
Mailing Address - Street 1:1608 LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5856
Mailing Address - Country:US
Mailing Address - Phone:219-476-0352
Mailing Address - Fax:219-531-0859
Practice Address - Street 1:1000 E 80TH PL
Practice Address - Street 2:SUITE 308 SOUTH TOWER
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5608
Practice Address - Country:US
Practice Address - Phone:219-736-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING15815Medicare UPIN
IN222180BMedicare ID - Type Unspecified