Provider Demographics
NPI:1881609295
Name:SAMAD, MARWAN ABDUL (MD)
Entity type:Individual
Prefix:
First Name:MARWAN
Middle Name:ABDUL
Last Name:SAMAD
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 1:8224 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1704
Mailing Address - Country:US
Mailing Address - Phone:219-836-1855
Mailing Address - Fax:219-836-0527
Practice Address - Street 1:8224 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1704
Practice Address - Country:US
Practice Address - Phone:219-836-1855
Practice Address - Fax:219-836-0527
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040993A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100319360AMedicaid
IN100319360AMedicaid
IN100319360AMedicaid