Provider Demographics
NPI:1831187244
Name:LAKHANI, ABDUS SAMAD (MD)
Entity type:Individual
Prefix:
First Name:ABDUS
Middle Name:SAMAD
Last Name:LAKHANI
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:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-0552
Mailing Address - Country:US
Mailing Address - Phone:219-464-9800
Mailing Address - Fax:219-464-9877
Practice Address - Street 1:2701 LEONARD DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-464-9800
Practice Address - Fax:219-464-9877
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044934A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200178180AMedicaid
ING44756Medicare UPIN
IN143010Medicare ID - Type Unspecified
IN200178180AMedicaid