Provider Demographics
NPI:1396787479
Name:RIFAI, MOHAMAD HYTHAM (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:HYTHAM
Last Name:RIFAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:M. HYTHAM
Other - Middle Name:
Other - Last Name:RIFAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 E 89TH AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7318
Mailing Address - Country:US
Mailing Address - Phone:219-756-2900
Mailing Address - Fax:219-756-2910
Practice Address - Street 1:200 E 89TH AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7318
Practice Address - Country:US
Practice Address - Phone:219-756-2900
Practice Address - Fax:219-756-2910
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035906207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN087388OtherANTHEM
IN100214490AMedicaid
IN129164100OtherINDIANA DEPT OF LABOR
IN140000847OtherPALMETTO RR MEDICARE
IN129164100OtherINDIANA DEPT OF LABOR
INC25489Medicare UPIN