Provider Demographics
NPI:1457414310
Name:ALBERT, RAPHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:E
Last Name:ALBERT
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 1:751 E 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5538
Mailing Address - Country:US
Mailing Address - Phone:219-791-9476
Mailing Address - Fax:219-791-9542
Practice Address - Street 1:751 E 81ST AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5538
Practice Address - Country:US
Practice Address - Phone:219-791-9476
Practice Address - Fax:219-791-9542
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030144A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN00000089302OtherPROVIDER BCBS NUMBER
IN080100660OtherRAILROAD PROVIDER NUMBER
IN405150TMedicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER
IN00000089302OtherPROVIDER BCBS NUMBER