Healthcare Provider Details

I. General information

NPI: 1922425453
Provider Name (Legal Business Name): ISLAM ADEL BADAWY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ISLAM ADEL BAGHDADY

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12750 ST FRANCIS DR STE 320
CROWN POINT IN
46307-0264
US

IV. Provider business mailing address

1400 S LAKE PARK AVE STE 400
HOBART IN
46342-6791
US

V. Phone/Fax

Practice location:
  • Phone: 219-662-0077
  • Fax: 219-662-9496
Mailing address:
  • Phone: 219-942-6166
  • Fax: 219-942-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number02005065A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number02005065A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number02005065A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: