Healthcare Provider Details

I. General information

NPI: 1306030648
Provider Name (Legal Business Name): KAMRAN JAVAID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ARCADE AVE STE 210
ELKHART IN
46514-2485
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-389-5656
  • Fax: 574-523-7891
Mailing address:
  • Phone: 574-647-6592
  • Fax: 574-647-1821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01075708A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01075708A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: