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NPI Code Detail

MEDICARE: DR. ABDELRAHMAN M ABDALLA MD

MEDICARE: DR. ABDELRAHMAN M ABDALLA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician01058910AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000342198OTHERINANTHEM BLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
301058910AOTHERININ LICENSE

General Provider Information

NPI Number : 1477729234
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ABDELRAHMAN M ABDALLA MD
Provider Business Mailing Address
First Line : 911 N SHELBY ST
Second Line :
City : SALEM
State : IN
Zip : 47167-2304
Country : US
Telephone Number : 812-896-0108
Fax Number : 812-883-8556
Provider Business Practice Location Address
First Line : 911 N SHELBY ST
Second Line :
City : SALEM
State : IN
Zip : 47167-2304
Country : US
Telephone Number : 812-896-0108
Fax Number : 812-883-8556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2008
Last Update Date : 05/01/2008

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